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PRACTICAL ANATOMY 



PRACTICAL ANATOMY. 



A NEW ARRANGEMENT 



OF THE 



LONDON DISSECTOR, 



NUMEROUS MODIFICATIONS AND ADDITIONS, 

CONTAINING 

A CONCISE DESCRIPTION OF THE MUSCLES, BLOODVESSELS, NERVES, 

VISCERA, AND LIGAMENTS OF THE HUMAN BODY AS 

THEY APPEAR ON DISSECTION. 

WITH ILLUSTRATIONS. 



BY 

D. HAYES AGNEW, M. D., 

OS AXATOMr, AXD SUjRfigfljfciDjrHE PHILADELPHIA HOSPITAL (BLOCKLEY). 




PHILADELPHIA: 

J. B. LIPPINCOTT AND CO 

1856. 






Entered according to the Act of Congress, in the year 1856, by 
J. B. LIPPINCOTT AND CO., 



Eastern District of Pennsylvania. 



0*» 



PEEEACE 



THE AMERICAN EDITOR. 



The Editor of the following pages, believing that a 
dissector suited to the wants of the American Student 
should be much more condensed than those in general 
use, has made the following arrangement of the London 
Dissector. In its preparation the arrangement has been 
entirely altered, and the nomenclature in many cases 
changed. The Ligamentous system: illustrations and 
numerous other additions in various parts of the work 
have been made; everything considered unnecessary 
erased, and the whole presented as near as possible in 
topographical order. The minute anatomy of parts and 
the smaller ramifications of the nervous and vascular sys- 
tems have been omitted, belonging as they do more pro- 
perly to systematic treatises on Special Anatomy. 

The work has been prepared with a single eye to the 
faithful economy of the Student's time. 

D. HAYES AGNEW. 

August, 1856. 



CONTENTS 



PAGE 

CHAPTER I. 

General Observations in Reference to Dissecting ... 13 



CHAPTER II. 
Dissection of the Head 14 

CHAPTER III. 
Dissection of the Face 18 

CHAPTER IV. 
Of the Contents of the Cranium, or the Brain and its Membranes 36 

CHAPTER V. 

Dissection of the Anterior Part of the Neck . . . .58 

CHAPTER VI. 
Dissection of the Throat 82 

CHAPTER VII. 
Dissection of the Orbit of the Eye 91 

CHAPTER VIII. 
Dissection of the Thorax 97 

CHAPTER IX. 
Dissection of the Superior Extremity 103 



Vlll CONTENTS. 



PAGE 

CHAPTER X. 
Dissection of the Abdomen 143 



CHAPTER XII. 
Dissection of the Anterior Part of Thigh . 177 

CHAPTER XIII. 
Dissection of the Perineum and of the Male Organs of Gene- 
ration 223 

CHAPTER XIV. 

Dissection of the Organs of Generation in the Female . . 239 

CHAPTER XV. 
Of Parts within the Thorax ' . . 247 

CHAPTER XVI. 

Dissection of the Muscles on the Posterior Part of the Trunk 

and Neck • . 264 

CHAPTER XVII. 

Dissection of the Muscles situated between the Ribs, and on the 

Inner Surface of the Sternum 278 

CHAPTER XVIII. 

Dissection of the Eye 280 

CHAPTER XIX. 
Ligaments 283 



PRACTICAL ANATOMY 



CHAPTEK I. 



GENERAL OBSERVATIONS IN REFERENCE TO 
DISSECTING. 

The student about commencing the duties of the dis- 
secting room, should be supplied with a good apron to 
protect his clothes from being soiled, and a dissecting 
case of a good quality. The knife should be held like a 
pen and moved by the fingers and thumb, not by the 
wrist and elbow, and sometimes, as I have seen, by the 
shoulder. The student should practice its use also with 
the left hand; such an education will be of great advan- 
tage, especially in surgical operations. In the dissection 
of a part, it is a good rule not to turn off more of the skin 
than is necessary for the exposure of the part, and always 
to replace it again during the interval of dissection. 
Generally I think it better to turn off the structures ia 
the order of superposition ; as the skin, superficial fascia, 
deep fascia, &c. In dissecting a muscle the parts should 
be made tense, which is done by blocks properly placed 
under the subject. The cellular membrane which imme- 
diately invests the muscle, must be kept extended by the 
hand or forceps, and the edge of the knife carried steadily 
in the direction of its fibres. This rule admits of no ex- 
ceptions, and should never be lost sight of by the student. 

There are many operations which mav be done on the 
2 



14 PRACTICAL ANATOMY. 

subject without injuring the parts for dissection ; such 
as the ligation of arteries ; passage of instruments through 
the nasal fossce and their introduction into the Eustachian 
tube ; introduction of catheter, both in the male and female, 
&c. ; and these should be practised with care. The grand 
•object of the student in the examination of the human 
body, should be not only to recognize its constituents : 
but above all the relation which they sustain to each other 
this is the only knowledge worth obtaining, and the want 
of it accounts for the blunders, confusion and ignorance 
which are so frequently seen in the profession. Another 
point of much importance is order and cleanliness. Hence 
all drippings from the subject should be wiped up with 
the sponge, and no scraps allowed to accumulate about the 
table. Much apprehension is sometimes expressed by 
students of being poisoned. It is w r ell if there be any 
abrasions of the skin to cover it with collodion before 
engaging in dissecting; but since the introduction of the 
chloride of zinc as an antiseptic all danger from this source 
is removed. Where an accidental cut is inflicted, the 
part should be washed, and well drawn by the mouth. 
The common practice of cauterizing with the nitras 
argenti, I think is in many cases positively injurious. 



CHAPTER II. 
DISSECTION OF THE HEAD. 

OF THE EXTERNAL PARTS OF THE HEAD. 

The integuments of the head are thick, and covered 
with hair; under the cutis there is a cellular substance, 
which is much condensed, and closely connected with the 
epicranium, or expanded tendon of the occipito-frontalis. 
This connection renders the dissection of that muscle 
difficult. 



NERVES. 15 

An incision should be made from the root of the nose 
over the median line of the head, terminating behind at 
the occipital protuberance. A second from the com- 
mencement of the first, over the eyebrows to the external 
angular process of the frontal bone ; a third from the 
occipital protuberance to the mastoid process of the tem- 
poral bone; by dissecting very carefully the flap outwards, 
the entire muscle and intervening tendon or aponeurosis 
will be exposed. 

The Occipito-frontalis is the only muscle which 
properly belongs to the hairy scalp; it is a single broad 
digastric muscle, 

Arising, on each side of the head, fleshy and tendinous, 
from the transverse ridge of the occipital bone, as far 
forwards as the mastoid process ; it forms a broad thin 
tendon, which covers the whole upper part of the cra- 
nium. 

Inserted, fleshy, on each side, into the orbicularis pal- 
pebrarum, skin of the eyebrows, and the internal angular 
process of the os frontis and os nasi. The last insertion 
answers to the Pyramidalis Nasi of some books. 

Situation. — The tendon adheres firmly by cellular mem- 
brane to the skin, jDut very loosely to the pericranium, 
or periosteum of the cranium, by a loose cellular layer, 
which might be called the subaponeurotic fascia. At its 
insertion it intermixes with the muscles of the upper part 
of the face. 

Use: To pull the skin of the head backwards, raise 
the eyebrows, and corrugate the skin of the forehead. 

Bloodvessels seen in the dissection of the scalp are 
the Frontal, emerging from the internal angle of the 
orbit and passing up the middle of the head; supraorbital 
out of the Supraorbital foramen ; both branches of the 
Ophthalmic. On the side of the head the Temporal, 
from the external carotid, behind the Posterior Occipi- 
tal, and Posterior Auricular from the external caro- 
tid. All anastomose in the scalp. 

Nerves coming out of the supraorbital foramen: The 
Frontal Nerve, a branch of the ophthalmic, which last is 
the first branch of the fifth pair ; on the side, branches of 



16 PRACTICAL ANATOMY. 

the Portio Dura and Inferior Maxillary Nerves; 
and behind, the Occipitalis Minor and Major — the for- 
mer from the superficial plexus of the neck, and the lat- 
ter the main stalk of the second cervical spinal nerve. 

The muscles of the ear are of three classes. 

1. The common muscles move the external ear; they 
are not always so distinct as to admit of a clear demon- 
stration. 

(1.) Attollens Aurem — Arises from the tendon of the 
occipito-frontalis, and from the aponeurosis of the tem- 
poral muscle. 

Inserted into the upper part of the root of the cartilage 
of the ear, opposite to the antihelix. 

Use : To draw the ear upwards. 

(2.) Anterior Auris — Arises, thin and membranous, 
from the posterior part of the zygomatic process of the 
temporal bone. 

Inserted into a small eminence on the back of the helix, 
opposite to the concha. 

Use: To draw the eminence a little forwards and up- 
wards. 

(3.) The Ketrahentes Auris — Arise, by two or three 
distinct slips, from the external and posterior part of the 
mastoid process, immediately above the insertion of the 
sterno-cleiclo mastoideus. 

Inserted into that back part of the ear which is opposite 
to the septum, dividing the scapha and concha. 

Use: To draw the ear back and stretch the concha. 

Before describing the proper muscles of the ear, notice 
the following: The part usually called ear is for the most 
part cartilaginous ; appended to it below is a pendulous 
portion, the Lobus, composed of granulated fat and 'dense 
cellular membrane: with the exception of this, all above 
is the Pinna. The deep cavity in the middle is the 
Concha. Dividing the upper part of the concha into 
two unequal fossae is a ridge which runs along the cir- 
cumference of the pinna and ends in the lobus ; this is 
the Helix — within it another, the Antihelix. On the 
anterior .part of the concha is a projection, the Tragus, 
and opposite another, the Antitragus. Under the rim 



TRANS VERSUS AURIS. 17 

of the helix is the Fossa Innominata, and between the 
bifurcation of the helix is the Scapha. The external 
Auditory Meatus is about one inch in depth, its direc- 
, tion moderately forward; under the skin which lines the 
meatus are the Ceruminous Glands. 

2. The proper muscles of the ear must be here de- 
scribed ; but the student must not expect to meet with 
them distinctly marked in every subject : in general, they 
are very confused and indistinct. 

(1.) Helicis Major — Arises from the upper and acute 
part of the helix, anteriorly. 

Inserted into its cartilage, a little above the tragus. 

Use: To depress the part from which it arises. 

(2.) Helicis Minor — Arises from the inferior and an- 
terior part of the helix. 

Inserted into the crus of the helix, near the fissure on 
the cartilage opposite to the concha. 

Use: To contract the fissure. 

(3.) Tragicus — Arises from the middle and outer part 
of the concha, at the root of the tragus, along which it 
runs. 

Inserted into the point of the tragus. 

Use: To pull the point of the tragus a little forwards. 

(4.) Antitragicus — Arises from the internal part of 
the cartilage that supports the antitragus; and, running 
upwards, is 

Inserted into the tip of the antitragus as far as the infe- 
rior part of the antihelix. 

Use: To turn the tip of the antitragus a little outwards, 
and depress the extremity of the antihelix towards it. 

(5.) Trans versus Auris— Arises from the prominent 
part of the concha on the dorsum of the ear. 

Inserted opposite to the outer side of the antihelix. 

Use: It draws the parts to which it is connected to- 
wards each other, and stretches the scapha and concha. 



18 PRACTICAL ANATOMY. 



CHAPTER III. 
DISSECTION OF THE FACE. 

OF THE MUSCLES. 

To expose these muscles an incision should be carried 
from the root of the nose to its tip, around the margin 
of the nostril to the centre of the upper lip, down to its. 
margin, around its border to an opposite point on the 
lower lip, and then to the symphysis of the chin. From 
the termination of the last a second may be carried along 
the base of the jaw to the mastoid process of the temporal 
bone. Reflect the integuments outwards. 

Under the integuments of the face, there is always a 
considerable quantity of adipose membrane ; many of the 
muscles are very slender, and lying embedded in this fat, 
require careful dissection. The whole side of the face is 
also supplied with numerous ramifications of the facial 
nerve, or portio dura of the seventh pair. These nervous 
twigs are generally removed with the integuments. If it 
is desired to save them, the skin only should be removed 
first. 

Twelve pairs of muscles, and one single muscle, are 
described in this dissection. 

1. The Orbicularis Palpebrarum — Arises from the 
internal angular process of the frontal bone, and from a 
tendon at the inner angle of the eye, by a number of 
fleshy fibres which pass round the orbit, covering first 
the superior and then the inferior eyelid, and also the 
bony edges of the orbit. 

Inserted, by a short round tendon, the Tendo Oculi, 
into the nasal process of the superior maxillary bone. 
The above tendon lies across the lachrymal sac. 



LEVATOR LABII SUPERIORIS ALiEQUE JNASI. 19 

Situation: This muscle is intermixed, at its upper part, 
with the occipito frontalis. 

Use: To shut the eye, by bringing down the upper lid, 
and pulling up the lower ; the fibres contracting towards 
the inner angle, as to a fixed point, compress the eyeball 
and lachrymal gland, and convey the tears towards the 
puncta lachrymalia. 

The ciliaris is only a part of the muscle covering the 
cartilages of the eyelids, which are called the Cilia or 
Tarsi ; Maxillo-palpebral. 

2. The Corrugator Supercilii — Arises, fleshy, from 
the internal angular process of the os frontis ; it runs out- 
wards and a little upwards, to be 

Inserted into the inferior fleshy part of the occipito- 
fron talis muscle, extending outwards as far as the middle 
of the superciliary ridge. 

Situation: This muscle is concealed by the occipito- 
frontalis. It lies close to the upper and inner part of the 
orbicularis palpebrarum, with which it is connected. 

Use : To smooth the skin of the forehead, by pulling 
it down after the action of the occipito-frontalis. When 
it acts more forcibly, it pulls down the eyebrow and skin 
of the forehead, and produces vertical wrinkles. 

3. The Compressor Naris — Arises, narrow, from the 
outer part of the ala nasi, and neighboring part of the os 
maxillare superius. From this origin a number of thin 
separate fibres run up obliquely along the cartilage of the 
nose towards the dorsum nasi, where the muscle joins its 
fellow, and is 

Inserted, slightly, into the lower part of the os nasi and 
nasal process of the superior maxillary bone. 

Situation : It is superficial ; its origin is connected with 
the levator labii superioris akeque nasi. 

Use : To compress the ala towards the septum nasi ; 
but, if the fibres of the occipito-frontalis, which adhere to 
it, act, the upper part of this muscle assists in pulling the 
ala outwards : It also corrugates the skin of the nose. 

4. Levator Labii Superioris Al^ique Nasi — Arises 
by two distinct origins : the first from the nasal process of 
the superior maxillary bone, where it joins the os frontis at 






20 PRACTICAL ANATOMY. 

.the inner canthus of the e} r e ; it descends along the nasal 
process, and is inserted into the outer part of the ala nasi, 
and into the upper lip. The second arises, broad and 
fleshy, from the margin of the orbitar process of the supe- 
rior maxillary bone, immediately above the foramen in- 
fra-orbitarium ; it runs down, becoming narrower, and is 
inserted into the upper lip and orbicularis oris. 

Situation : The first portion is sometimes called Levator 
Labii Superioris Alasque Nasi, and the second Levator 
Labii Superioris Proprius. Their origins are partly 
covered by the orbicularis palpebrarum. They descend 
more outwardly than the ala nasi. 

Use: To raise the upper lip towards the orbit, and a 
little outwards ; the first portion will also draw the ala 
nasi upwards and outwards. 

Bloodvessels and Nerves. — Below the orbital ori- 
gin of this muscle will be seen the Infraorbital Blood- 
vessels and Nerve coming out of the infraorbital fora- 
men. The artery is from the internal maxillary, the 
nerve from the superior maxillary branch of the fifth 
pair. 

5. Zygomaticus Minor — Arises from the upper promi- 
nent part of the os mahe, and, descending obliquely down 
wards and forwards, is 

Inserted into the upper lip near the corner of the 
mouth. 

. Situation: Its origin is covered by the orbicularis pal- 
pebrarum. 

Use: To draw the corner of the mouth and upper lip 
obliquely upwards and outwards. 

6. Zygomaticus Major — Arises, fleshy, from the os 
malse, near the zygomatic suture. 

Inserted into the angle of the mouth, appearing to be 
lost in the depressor anguli oris, and orbicularis oris. 

Situation: Its origin is partially covered by the orbicu- 
laris palpebrarum ; it lies more outwardly than the zygo- 
maticus minor/ 

Use : To draw the corner of the mouth and under lip 
upwards and outwards. 

7. The Levator Anguli Oris — Arises, thin and fleshy, 



BUCCINATOK. 21 

from a depression of the superior maxillary bone betwixt 
the root of the socket of the first dens molaris, and the 
foramen infraorbitarium. 

Inserted, narrow, into the angle of the mouth. 

Situation : It lies more outwardly than the levator labii 
superioris alaeque nasi ; it is in part concealed by that 
muscle, by the zygomaticus minor, and part of the zygo- 
maticus major. At its insertion it is connected with the 
depressor anguli oris. 

Use : to draw the corner of the mouth upwards. 

8. The Depressor Anguli Oris — Arises, broad and 
fleshy, from the lower edge of the inferior maxillary 
bone, at the side of the chin, and gradually becoming 
narrower, is 

Inserted into the angle of the mouth. 

Situation: This muscle is firmly connected with the 
platysma myoides ; at its insertion it is blended with the 
zygomaticus major and levator anguli oris. 

Use: To pull down the corner of the mouth. 

9. The Depressor Labii Inferioris — Arises, fleshy 
and broad, from the side of the lower jaw, a little above 
its lower edge ; it runs obliquely upwards and inwards, 
and is 

Inserted into the edge of the under lip. 

Situation : This muscle, at its insertion, decussates with 
its fellow. It is in part covered by the depressor anguli 
oris. It forms the thick part of the chin, and has its 
fibres interwoven with fat. 

Use: To pull the under lip downwards. 

10. The Buccinator — Arises, tendinous and fleshy, 
from the lower jaw as far back as the root of the coronoid 
process; from the upper jaw, as far back as the pterygoid 
process of the sphenoid bone ; it then continues to arise 
from the alveolar processes of both jaws, as far forwards 
as the dentes cuspidati. The fibres run forward, and 
are 

Inserted into the angle of the mouth. 

Situation: This muscle lies deep, adheres to the mem- 
brane that lines the mouth; and a quantity of fat is 
always found between its fibres and the other muscles 



22 



PRACTICAL ANATOMY 
Pic. 1. 




Muscles of the Face. 



10. 
11. 
12. 
13. 
14. 



Frontal portion of the Occipito- 
Frontalis. 

Its Posterior or Occipital por- 
tion. 

Its Aponeurosis. 

Orbicularis Palpebral, which 
conceals the Corru gator Su- 
percilii, and Tensor Tarsi of 
Horner. 

Pyramidalis Nasi. 

Compressor Naris. 

Orbicularis Oris. 

Levator Labii Superioris Alae- 
que Nasi. 

Levator Labii Superioris. 

Zygomaticus Minor. 

Zygomaticus Major. 

Depressor Labii Inferioris. 

Depressor Anguli Oris. 

Levator Labii Inferioris. 



15. Superficial Portion of the Mas- 

seter. 

16. Its Deep Portion. 

18. Buccinator. 

19. Attollens Auriculae Muscle. 

20. Temporal Aponeurosis which 

conceals the Temporal Mus- 
cle. 

21. Retrahens Auriculae Muscle. 

22. Anterior Belly of the Digas- 

tric — the Tendon is seen 
passing through the Loop 
formed by the Cervical Fas- 
cia. 

23. Stylo-hyoid Muscle. 

24. Mylo-hyoid Muscle. 

25. Sterno-mastoid Muscle. 

26. Upper part of the Trapezius — • 

the Muscle between 25 and 
26 is the Splenius. 



and integuments. It is partly concealed by the masseter, 
and by the muscles which pass to the angle of the mouth, 
as the levator and depressor anguli oris, and zygomaticus 
major. It is inserted behind these muscles. In the cheek 
it is connected with the platysma myoides. 



DEPRESSOR LABII SUPERIORIS ALJ4QUE NASI. 23 

Use: To draw the angle of the mouth backwards and 
outwards, and to contract its cavity, by pressing the 
cheek inwards. 

The single muscle is the 

Orbicularis Oris. — It consists of two planes of semi- 
circular fibres, which decussate at the angles of the mouth. 
These fibres are formed chiefly by the muscles which are 
inserted into the lips ; they surround the mouth. The 
superior portion runs along the upper lip, the inferior 
portion'along the under lip. 

Situation: It is connected and intermixed with the in- 
sertions of all the preceding muscles of the face. Some of 
the fibres are connected to the septum nasi, and are by 
Albinus termed Nasalis Labii Superioris. 

Use: To shut the mouth by contracting and drawing 
both lips together. 

At this stage of the examination the Facial Ar- 
tery will be brought into view, a branch of the external 
carotid mounting over the lower jaw in front of the mas- 
seter muscle, passing under the depressor anguli oris and 
ascending as high as the angle of the eye, where it is 
called Angular Artery. Its branches, enumerated from 
beloyf upwards, are as follows. Masseter branches to the 
masseter and buccinator muscles. Inferior Labial to 
muscles of the lower lip, Inferior Coronary to edge of 
lower lip. Superior Coronary along the edge of the 
upper lip. Lateralis Nasi to the ala and septum of the 
nose. Nerves. — Anterior Dental, some distance back 
from the symphysis of the lower jaw, comes out of the 
anterior dental foramen, and is the termination of the infe- 
rior maxillary or 3d branch of the 5th pair. Any 
filaments coming forward from the outer portion of the 
face are from the portio dura of the 7th pair. 

11. Depressor Labii Superioris Aljeque Nasi — 
Arises, thin and fleshy, from the os maxillare superius, 
where it forms the alveoli of the dentes incisiva and dens 
caninus ; thence it runs up under part of the levator labii 
superioris akeque nasi. 

Inserted into the upper lip and root of the ala nasi. 

Situation: It is concealed by the orbicularis oris and 



24 PEACTICAL ANATOMY. 

levator labii superioris alaeque nasi. It may be discovered 
by inverting the upper lip, and dissecting on the side of 
the frsenum, which connects the lip to the gums. 

Use : To draw the upper lip and ala nasi downwards 
and backwards. 

12. The Levator Labii Inferioris — Arises from the 
lower jaw at the root of the alveolus of the lateral incisor. 

Inserted into the under lip and the skin of the chin. 

Situation :. Those two small muscles are found by the 
side of the frsenum of the lower lip. They lie under the 
depressor labii inferioris. 

On the side of the face we observe two strong muscles, 
and two other muscles are concealed by the angle of the 
inferior maxilla. 

Behind the masseter and overlaying a portion of it is 
the Parotid Gland (a salivary gland). It is wedged in 
between the angle and ramus of the jaw and the cartilage 
of the ear, extending up as high as the zygoma, and down 
into the neck. Its deep surface rests upon the styloid 
process of the temporal bone and is insinuated into all 
the irregularities about this point : its color is pinkish, and 
consists of lobules held together by cellular tissue. It 
has no proper capsule, but is covered by the extension of 
the fascia of the neck. The external carotid artery runs 
through its substance, giving it many branches, called 
Parotidean ; and the Portio Dura, or facial nerve, after 
it escapes from the stylo-mastoid foramen, passes through 
it also on its way to the face, and its several branches 
form a looped connection over the masseter called the 
Pes Anserinus. From the anterior and upper part, a 
white canal (sometimes two for a little ways) passes for- 
ward over the masseter muscle to its anterior edge, be- 
neath which it dips, and, perforating the buccinator emp- 
ties into the mouth opposite 2d molar of the upper jaw. 
This is the Parotid Duct (duct of Steno). It is accompa- 
nied by branches of the portio dura nerve, and the Trans- 
verse Facial Artery from the external carotid. 

1. The Masseter is divided into two portions, which 
decussate one another. 

The Anterior Portion arises, tendinous and fleshy, from 



TEMPORALIS. 25 

the superior maxillary bone, where it joins the os malas; 
from the lower edge of the os malae, and from its zygomatic 
process. The strong fibres run obliquely downwards and 
backwards, and are inserted into the outer surface of the 
side of the lower jaw, extending as far back as its angle. 

The Posterior Portion arises, principally fleshy, from 
the inferior surface of the os malas, and of the whole of 
the zygomatic process, as far back as the tubercle before 
the socket for the condyle of the lower jaw. The fibres 
slant forwards, and are inserted, tendinous, into the outer 
surface of the coronoid process of the lower jaw. 

Situation: The anterior portion conceals almost the 
whole of the posterior portion. The greater part of this 
muscle is superficial. Below it is covered by the pla- 
tysma myoides ; and above, a small portion of it is con- 
cealed by the origin of the zygomaticus major. 

Use: To pull the lower to the upper jaw, and to move 
it forwards and backwards. 

2. Temporalis — Arises, fleshy, from a semicircular 
ridge in the lower and lateral part of the parietal bone, 
from all the squamous portion of the temporal bone, 
from the external angular process of the os frontis, from 
the temporal process of the sphenoid bone, and from an 
aponeurosis which covers the muscle. From these dif- 
ferent origins the fibres converge, descend under the bony 
jugum formed by the zygomatic processes of the temporal 
and cheek bones. 

Inserted, by a strong tendon, into the upper part of the 
coronoid process of the lower jaw, to which it adheres on 
every side, but more particularly its forepart, where the 
insertion is continued down to near the last dens molaris. 
If the zygoma is removed a better view will be had. 

Situation: This muscle is of a semicircular shape. It 
is covered by a fascia or aponeurosis. This fascia ad- 
heres to the bones which give origin to the upper part of 
the muscle, and, descending over it, is inserted into the 
jugum and adjoining part of the os malae and os frontis. 
This insertion is by two leaves, leaving a space between 
containing some fat. The temporalis, at its origin, lies 
under the expanded tendon of the occipito-frontalis, and 
3 



26 



PRACTICAL ANATOMY. 



under the small tendons which move the external ear. 
Its insertion is concealed by the jugum and by the mas- 
seter; so that, to expose it, the masseter must be cut 
away. 

Use: To pull the lower jaw upwards and press it 
against the upper. 



Fig. 2. 

The two Pterygoid Muscles. The Zygomatic Arch and the greater 
part of the ramus of the lower jaw have been removed, in order 
to bring these muscles into view. 



1. The Sphenoid Origin of the Exter- 

nal Pterygoid Muscle. 

2. Its Pterygoid Origin. 

3. The Internal Pterygoid Muscle. 




In order to expose the following muscles, we must re- 
move the muscles of the cheek and jaw, the masseter and 
insertion of the temporalis must be taken away, and the 
coronoid process of the inferior maxilla removed by a 
saw. 

8. The Pterygoideus Externus — Arises from the 
outer side of the external plate of the pterygoid process 
of the sphenoid bone, from part of the tuberosity of the 
os maxillare adjoining to it, and from the root of the 
temporal process of the sphenoid bone. It passes back- 
wards and outwards, to be 

Inserted into a depression in the neck of the condyloid 
process of the lower jaw, and into the anterior and inner 
part of the ligament of the articulation of that bone. 

Situation: This muscle passes almost transversely from 
the skull to its insertion. It is concealed by the muscles 
of the face and neck, and by the ascending processes of 
the lower jaw. 



INTERNAL MAXILLARY. 27 

Use: When this pair of muscles act together, they 
bring the jaw horizontally forwards. When they act 
singly, the jaw is moved forwards, and to the opposite 
side. 

4. The Pterygoideus Internus — Arises, tendinous 
and fleshy, from the inner and upper part of the internal 
plate of the pterygoid process of the sphenoid bone, filling 
all the space between the two plates ; and from the ptery- 
goid process of the os palati between these plates. 

Inserted, by tendinous and fleshy fibres, into the inside 
of the angle of the lower jaw. 

Situation: To expose this muscle, the jaw must be re- 
moved from its articulating cavity, and then pulled for- 
wards, and toward the opposite side ; or it may be sawn 
across at its symphysis, and the other half removed. It is 
larger than the pterygoideus externus ; and between the 
two muscles there is a considerable quantity of cellular 
membrane, and the trunk of the Inferior Maxillary 
and Gustatory Nerves. Like that muscle, it is con- 
cealed by the lower jaw and facial muscles. Along its 
posterior edge, we observe the Ligamentum Laterale 
Maxillas Inferioris, a ligamentous band, which exteuds 
from the back part of the styloid process to the angle of 
the lower jaw. 

Use: To draw the jaw upwards, and obliquely towards 
the opposite side. 

ARTERIES. 

The External Carotid is found ascending behind the 
parotid gland. It perforates the gland at its upper part, 
ascends over the zygomatic process immediately before 
the ear, and divides into the anterior, middle, and poste- 
rior temporal arteries, which ramify over the side of the 
head, giving also branches to the forehead and occiput. 

The Internal Maxillary passes behind the condy- 
loid process of the lower jaw ; it directs its course towards 
the bottom of the orbit of the eye ; and it is at this point 
that it sends off its numerous branches. (1.) Arteria 
Media Durje Matris, passes through the spinal hole of 
the sphenoid bone into the cranium, and is distributed to 



28 



PRACTICAL ANATOMY. 



the dura mater. (2.) A. Maxtllaris Inferior, vel Den- 
talis Inferior, runs downwards, eaters the foramen at the 
root of the ascending processes of the lower jaw, then 
passes through the canal of the lower jaw ; supplying the 
teeth and sockets, and emerges by the foramen mentale, 
to be distributed to the chin. It is accompanied by a 
nerve and one or two veins. (3.) A. Pterygoide^e and 
A. Tempos ales Profunda, are small branches of the 
internal maxillary which pass to the pterygoid muscles, 
and to the inner part of the temporal muscle. (4.) A. 
Pharynge^e, branches to the pharynx, palate, and base 
of the skull. (5.) A. Alveolaris, which gives branches 
to the teeth of the upper jaw, and to the jaw bone itself. 
(6.) A Branch through the foramen spheno-palatinum to 
the nose ; and, (7.) An Artery through the palato-maxil- 
lary canal to the palate. 



Fig. 3. 
The Internal Maxillary Artery and its Branches. 



A. External Carotid Artery. 

Internal Maxillary Artery. 

Arteria Tympanica. 

Arteria Pterygoidea. 

Dentalis Inferior. 

Arteria Meningea Parva. 

Arteria Buccalis. 

Arteria Alveolaris, or Maxil- 
laris Superior. 
h. Arteria Meningea Magna. 

Infra-Orbitalis. 
d. Anterior Mental Artery. 




The continued trunk of the internal maxillary enters the 
orbit by the spheno-m axillary slit. It sends off a branch 
which runs along the inner side of the orbit, and passes out 
at the inner canthus of the eye on the forehead. The artery 
itself runs along the bottom of the orbit in a canal on 
the upper part of the great tuberosity of the os maxillare 
superius, and emerges by the foramen infra-orbitarium 



SUPERIOR CERVICAL NERVES. 29 

on the face ; hence it is termed A. Infra-Orbitaria, and is 
distributed to the cheek and side of the nose. 

The Frontal Artery is also seen in the dissection of 
the face, passing from the orbit through the foramen 
supra-orbitarium to be distributed to the forehead. This 
artery is sent off from the ophthalmic artery, which is a 
branch of the internal carotid. 

If the face be injected, a remarkable anastomosis of 
arteries will be observed at the inner angle of the eye. 

Veins. 

The veins of the face are numerous, and pass into the 
external and internal jugular veins. 

Nerves. 

1. The Portia Dura of the seventh pair, Kervus 
Communicans Faciei, or Facial nerve, after its course 
through the temporal bone in the aqueduct of Fallopius, 
comes out by the foramen stylo-mastoideum. It imme- 
diately gives off branches to the neighboring parts, as 
behind the ear. It then passes through the substance of 
the parotid gland, and emerges on the face in three great 
branches, which have frequent mutual communications : 
this division of the nerve is called Pes Anserinus. 

(1.) The ascending branch ramifies on the temple and 
forehead. 

(2.) The middle branch sends its ramifications over the 
side of the face, the proper Facial Nerves. 

(3.) The descending branch sends its twigs along 
the chin, down upon the neck, and backwards upon the 
occiput. 

2. The Superior Cervical Nerves send off several 
branches, which ramify on the side of the face and head, 
and communicate freely with the branches of the portio 
dura. 

As, in the course of this dissection, we meet with many 
twigs of the second and third branches of the fifth pair of 
nerves, it will be advisable here to describe this pair of 
nerves. 

a* 



so 



PRACTICAL ANATOMY. 



Fig. 4. 
The Distribution op the Facial Nerve and the Branches of the Cer- 
vical Plexus. 




1. The Facial Nerve (Portio Dura) escaping from the Stylo-mastoid 

Foramen, and crossing the Ramus of the Lower Jaw ; the Paro- 
tid Gland has been removed, in order to show the Nerve more 
distinctly. 

2. The posterior Auricular Branch ; the Digastric and Stylo-mastoid 

Filaments are seen near the origin of this branch. 

3. Temporal Branches communicating with (4) the Branches of the 

Frontal Nerve. 

5. Facial Branches communicating with (6) the Infra-orbital Nerve. 

7. Facial Branches communicating with (8) the Mental Nerve. 

9. Cervico-facial Branches communicating with (10) the Superficial 
Cervical Nerve, and forming a Plexus (11) over the Submaxillary 
Gland. The distribution of the branches of the facial in a radi- 
ated direction over the side of the face, and their looped com- 
munications, constitute the Pes Anserinus. 

12. The large Auricular Nerve, one of the Ascending Branches of the 

Cervical Plexus. 

13. The Small Occipital ascending along the Posterior Border of the 

Sterno-mastoid Muscle. 

14. The Superficial and Deep-descending Branches of the Cervical 

Plexus. 

The Spinal Accessory Nerve, giving off a Branch to the External 
Surface of the Trapezius Muscle. 

The Large Occipital Nerve, the Posterior Branch of the second Cer- 
vical Nerve. 



15. 



16 



NERVUS MAXILLAEIS SUPERIOR. 81 

1st. The Ophthalmic Nerve. The first branch of the 
fifth pair enters the orbit through the sphenoidal fissure. 
Its branches are the Frontal, which, passing above the 
levator palpebral muscles, escapes upon the forehead 
through the supra-orbital foramen. The Lachrymal 
passes along the upper edge of the external rectus muscle 
with the Lachrymal Artery to the Lachrymal Gland. 
Here it divides into two branches, one escaping through, 
the malar bone upon the cheek and temple, the other to 
the under part of the gland, and conj unctiva of the upper 
lid. 

The Nasal passes between the origins of the external 
rectus muscle, accompanies the ophthalmic artery and 
enters the anterior ethmoidal foramen, then up through 
the ethmoid bone to the cribriform plate, and then through 
the nasal slit in that plate into the nose, which supplies 
the mucous membrane and integuments of the nose. Its 
principal branches while in the orbit, are the Ganglionic, 
Ciliary, and infra-trochlear. 

3. Nervus M axillaris Superior, or second branch 
of the fifth pair. The superior maxillary nerve, having 
left the cranium by the foramen rotundum of the sphe- 
noid bone, emerges behind the antrum maxillare, at the 
lower back part of the orbit, and at the root of the ptery- 
goid process of the sphenoid bone. It immediately sends 
out branches : 1. A small branch which passes through 
the spheno-maxillary slit to the periosteum and fat of the 
orbit. 2. The largest branch is the Infra-Orbitary 
Nerve. It enters the channel in the top of the antrum 
maxillare, accompanying the infra-orbitary artery, comes 
out at the foramen infra-orbitarium, and is widely dis- 
tributed to the cheek, under lip, and outside of the nose, 
communicating with ramifications of the portia dura. 
3. Branches to the temporal muscle, os malas, &c. 4. 
Communicating branches with Meckel's ganglion. 5. 
Posterior dental branches through the foramina in the 
superior maxillary bone. 6. Twigs which supply the 
gums and alveoli of the upper jaw. 

4. Nervus Maxillaris Inferior, or third branch of 
the fifth pair. The inferior maxillary nerve leaves the 



32 PRACTICAL ANATOMY. 

cranium by the foramen ovale of the sphenoid bone. It 
has its course downwards and outwards ; and, having 
given twigs to the parts near which it passes, as the mas- 
seter, pterygoid, and temporal muscles, it divides at the 
angle of the jaw into two branches. 

1. Inferior Dental Nerve — Enters the foramen at the 
angle of the lower jaw, accompanies the Inferior Dental 
Artery along the canal in that bone, giving nerves to 
the teeth, emerges at the anterior mental foramen, and is 
distributed to the chin. 

2. The Gustatory or Lingual Nerve passes to the 
tongue. It lies close along the inner surface of the lower 
jaw, below the inferior edge of the-pterygoideus-internus, 
and above the mylo-hyoid will be seen when the neck is 
dissected. This nerve receives the chorda tympani. 

3. The Frontal Nerve, which comes from the first 
branch of the fifth pair through the supra-orbital foramen : 
it is distributed to the forehead. 

A general view of the distribution of the spinal nerves 
may be usefully subjoined in this place, to complete the 
description of the nerves. 

1. The Cervical Nerves consist of eight pairs ; they 
spread their branches over the side and back of the neck 
and nead, and to the muscles moving the head and 
shoulders. The superior nerves send branches to the 
sides of the head, and the inferior to the upper part of 
the chest and back. They also communicate freely with 
each other, and with all the neighboring nerves; — high 
in the neck, and under the jaw, with the portio dura of 
the seventh pair, with the fifth, eighth, and ninth pairs, 
and with the great sympathetic ; — towards the middle of 
the neck, with the descendens noni, the sympathetic and 
eighth pair, and in the lower part of the neck with the 
sympathetic. 

The Phrenic Nerve is formed by branches of the 
third, fourth, and fifth cervical nerves, passes obliquely 
down the neck through the thorax, then on each side of 
the pericardium, and is distributed to the diaphragm. 

The Axillary Plexus is formed by the principal parts 



NERVES. 33 

of the trunks of the fourth, fifth, sixth, and seventh cer- 
vical, and first dorsal nerves. 

2. The Dorsal Nerves are twelve pairs. — They arise 
from the spinal marrow in the same manner as the cervical. 
Each nerve emerges betwixt the heads of the ribs, gives 
twigs to the great sympathetic nerve, and twigs which 
pierce backwards to the muscles of the back ; then enter- 
ing the groove in the lower edge of each rib, it accompa- 
nies the intercostal artery, and runs towards the anterior 
part of the thorax, supplying the great muscles of the 
chest, giving twigs to the diaphragm, and muscles of the 
abdomen. 

3. The Lumbar Nerves are five pairs. They arise in 
the same manner ; their trunks are covered by the psoas 
magnus muscle. Each nerve gives twigs to the muscles 
of the loins and back, and to the sympathetic nerves, and 
runs obliquely downwards to supply the abdominal mus- 
cles and integuments of the groin and scrotum ; but the 
trunks of these nerves assist in forming the nerves of the 
thigh. 

4. The Sacral Nerves are five on each side, arising 
from the cauda equina. They come out through the an- 
terior foramina, and send small branches to the neighbor- 
ing parts ; but the great trunks of these nerves are united 
with the lumbar nerves, to form the nerves of the lower 
extremity, viz: 

(1.) The Anterior Crural Nerve, passing out under 
Poupart's ligament to the extensor muscles of the leg, is 
formed by branches of the first, second, third, and fourth 
lumbar nerves. 

(2.) The Obturator Nerve, leaving the pelvis by the 
thyroid holes, and being distributed to the deep-seated 
muscles on the inside of the thigh, arises from branches 
of the second, third, and fourth lumbar nerves. 

(3.) The Ischiatic or Sciatic Nerve, the greatest 
nerve of the body, passes out from the back part of the 
pelvis, through the sacro-sciatic notch, and takes its course 
along the back of the thigh, to supply the thigh, leg, and 
foot ; it is formed from the two last nerves of the loins 
and three first of the sacrum. 



34 PRACTICAL ANATOMY. 

All these nerves of the spine communicate freely by 
numerous twigs, and by the intervention of 

The Great Sympathetic Nerve, or Intercostal. — ■ 
This nerve, consisting of ganglia connected by cords, 
passes out of the cranium with the carotid artery. It 
then descends through the neck, and forms three gangli- 
ons in its course, which give twigs to the neighboring 
parts, and are joined by filaments from the cervical nerves, 
and the eighth and ninth pairs. The intercostal then enters 
the thorax, and descends by the side of the vertebra, be- 
hind the pleura, giving filaments, which, joining with twigs 
of the eighth pair, form several plexuses to supply the 
heart, lungs, &c. In the abdomen it descends on the 
lumbar vertebras, and at last terminates in the pelvis on 
the extremity of the coccyx. 

While in the thorax, it gives off a branch, which unit- 
ing with branches of the dorsal nerves, forms 

The Anterior Intercostal, or Splanchnic Nerve. 
— This nerve, passing betwixt the crura of the diaphragm, 
enters the abdomen, forms the semilunar ganglion, and 
is distributed by numerous plexuses to all the abdominal 
viscera. 

The eighth pair, or par vagum, has also a very long 
course ; it arises in the head, passes through the neck, to 
which it gives several branches. It enters the thorax 
anterior to the subclavian artery ; here it gives off a re- 
markable branch, called the Eecurrent, because it is re- 
flected round the arch of the aorta on the left side, and 
round the subclavian artery on the right, and ascends to 
be distributed on the trachea, oesophagus, and larynx. 
The nerve then passes through the thorax, and, entering 
the abdomen, terminates in the stomach ; in this course it 
has frequent communications with the great sympathetic, 
which it assists in forming the different plexuses that 
supply the thoracic and abdominal viscera. It is dis- 
tributed to the heart, lungs, liver, spleen, stomach, and 
duodenum. 



THE NOSE. 



35 



The Nose. 

The two openings in front are the Nostrils guarded 
by stiff hairs (vibrissa). The septum between the 
nostrils, the Columna; the tip of the nose, the Lobulus; 
sides (al^:). It is covered with great numbers of seba- 
ceous follicles : its form secured by five fibro-cartilages. 

1. Fibro-Cartilage of the Septum divides partly 
the nasal fossae into two. 

2. Lateral Fibro-Cartilage (2) connected above 
to the nasal bones and nasal process of superior max- 
illary, and below to the alar fibro-cartilage. 

3. Alar Fibro-Cartilages (two); each is curved to 
correspond to the nostril. The inner portion of each 



Fio. 5. 

The Nasal Cartilages, showing their Connection with each other 
and with the ossi nasi. 



1. Cartilage of tlie Septum. 
2, 2. Lateral Cartilages. 

3. Ala Cartilage. 

4. Cornua, or Appendices of the Ala Car- 

tilage. 

5. Nostril. 




coming together form the columiia. The ala3 are ex- 
tended by three or four fibro-cartilaginous appendages. 



36 PRACTICAL ANATOMY. 






CHAPTEE IV. 

OF THE CONTENTS OF THE CRANIUM, OR THE BRAIN 
AND ITS MEMBRANES. 

A transverse incision, extending from ear to ear 
over the crown of the head, being made through the 
tendon of the occipito-fron talis, the two flaps may, with 
facility, be inverted on the face and neck. Eemove the 
superior part of the cranium by a saw directed anteriorly 
through the frontal bone above the orbitar process, and 
posteriorly as low as the transverse ridge of the occipital 
bone. Thus the subsequent demonstration of the brain 
will be conducted with greater facility. 

When the superior part of the cranium, commonly 
called the Calvarium, or skull cap, is torn off, which re- 
quires considerable force, you expose the Dura Mater, 
a firm, compact, and whitish membrane, somewhat shining, 
rough on its outer surface, from the rupture of vessels 
which connected it to the cranium, and covered with 
bloody spots in consequence of the blood effused from 
these ruptured orifices. It is described as being separa- 
ble into many laminae (into two with facility); and it is 
said that these two laminae, by separating and reuniting, 
form the triangular cavities named Sinuses, which are in 
fact large veins. This division of layers can hardly be 
admitted as correct in the recent state of the membrane. 

The Superior Longitudinal Sinus lies in a groove 
formed by the two parietal bones ; it extends along the 
sagittal suture from the crista galli of the ethmoid bone 
to the middle of the os occipitis, where it bifurcates into 
the two lateral sinuses ; in its passage backwards, its size 
is increased. When slit open (which it should be), its 
triangular form is evident; it is lined by a smooth mem- 



ARTERIA MENINGEA MEDIA. 



37 



brane, and in it may be remarked the numerous open- 
ings of the veins of the pia mater opening forwards, the 
frena, or slips of fibres crossing from side to side, called 
^chord M willisii, glandulas Pacchioni interna?, et externa?, 
little bodies like millet-seed seen on the outer and inner 
surface of the sinus. 




Sinuses of the Dura Matek. 



1. Superior Longitudinal Sinus. 

2. Inferior Longitudinal Sinus. 

3. The two Venae Galeni. 

4. Sinus Quartus. 

5. Torcular Herophili. 
6, 6. The Lateral Sinuses. 

7. Inferior Petrous Sinus. 



8. Superior Petrous Sinus. 

9. Circular Sinus of Ridley. 

10. The two occipital Sinuses. 

11. Cavernous Sinus. 

12. Internal Jugular Veins. 

13. Veins of the Pia Mater. 



The arteries of the dura mater are divided into the 
anterior, middle, and posterior. 

1. Arteria Mentngea Media (called also the Spi- 
nalis or Spheno-spinalis), the great middle artery, is a 
branch of the internal maxillary ; it passes through the 



38 practical an atom y. 

spinous hole of the sphenoid bone, and is seen arising 
from the anterior inferior angle of the parietal bone (in 
a groove on which it lies), and spreading its numerous 
branches over the dura mater. 

The anterior and posterior arteries are small. 

2. A. Meningea Anterior is sent off from the external 
carotid, and enters the cranium by the foramen lacerum 
orbitale superius. 

3. A. Meningea Posterior is given off by the verte- 
bral artery ; the dara mater also receives small twigs from 
the occipital, pharyngeal arteries, &c. 

of the septa of the brain, or processes of the 
dura mater. 

1. The Falx (cerebri or major) is a long and broad 
fold, or duplicature of the inner lamina of the dura mater, 
dividing the cerebrum into two hemispheres, extending 
from the crista galli of the ethmoid bone, along the middle 
of the os frontis and point of junction of the two parietal 
bones, to the crucial ridge of the occipital bone, where it 
terminates in the middle of the next septum. 

2. The Tentorium Cerebelli, or transverse septum. 
This separates the cerebrum from the cerebellum, and is 
formed by the inner lamina of the dura mater, reflected 
off from the os occipitis along the groove of the lateral 
sinuses, and the edge or angle of the temporal bones. Its 
position is horizontal. 

There are some other folds of the dura mater not visi- 
ble in this stage of the dissection. 

3. The falx of the cerebellum, or small occipital sep- 
tum, will be seen when the cerebrum is removed. It ex- 
tends from the middle of the tentorium along the middle 
spine of the os occipitis to the foramen magnum, dividing 
the cerebellum into two parts. 

4. The sphenoidal folds, two small folds of the dura 
mater, one on each side of the sella turcica, stretching 
from the posterior to the anterior clinoid processes. 

The dura mater, also, in many parts of the brain, sepa- 
rates its laminas to form sinuses ; the principal of these 



THE DURA MATER. 39 

Fig. 7. 




Oblique View of the Interior of the Cranium as lined by the Dura 
Mater. 

1. Falciform Process. 

2. Its Superior or Attached Border containing the Longitudinal Sinus. 

3. Its Free Border. 

4. Continuation of the Falciform Process with (6) the Tentorium. 
7, 8. Free Concave Edge of the Tentorium. 

9. Termination of this edge at the Anterior Clinoid Process. 
10. Attached Border of the Tentorium continued along the Upper 
Angle of the Petrous Bone to the Posterior Clinoid Process. 

will be noticed in the course of the dissection. This 
membrane should now be divided in the line of the divi- 
sion of the cranium; its internal surface is smooth, glisten- 
ing, and free from adhesion, except in the course of the 
longitudinal sinus ; into which veins pass from the pia 
mater. 

Detach the falx from the crista galli, and turn it back- 
wards, observe in its lower edge the Inferior Longitu- 
dinal Sinus, which enters a sinus in the tentorium, 
termed the Straight Sinus. This will fully expose the 



40 PRACTICAL ANATOMY. 

convolutions of the brain, which are closely invested 
by the pia mater. 

1. The Tunica Arachnoides is a fine membrane, 
covering uniformly the surface of the pia mater, without 
passing into the interstices of its duplicatures. It is at- 
tached to it, is extremely thin, transparent, without ves- 
sels, demonstrated with difficulty on the upper surface of 
the brain by the blowpipe (which raises it into cells), 
but on the base of the brain it can be distinctly seen. 

2. The proper Pia Mater, or tunica vasculosa, is a very 
vascular membrane, transparent in the interstices of its 
vessels, investing the substance of the brain, descending 
betwixt all its convolutions, and lining its different cavi- 
ties ; but, where it lines the ventricles, it is fine, delicate, 
and less vascular, than on the surface, and betwixt the 
convolutions of the brain: It is connected to the dura 
mater by its veins passing into the longitudinal sinus. 

The brain is divided into three parts : 1. The cerebrum; 
2. The cerebellum ; 3. The medulla oblongata. 

The Cekebeum consists of two distinct substances : — 

1. The cortical or vesicular substance forming the outer 
part. 

2. The white medullary or tubular substance forming 
the inner part. 

The brain is divided by the falx into two hemispheres, 
and by the pia mater into numerous convolutions. 
Each hemisphere is divided into three lobes. 

1. The Anterior Lobes rest on that part of the cra- 
nium which forms the two orbits, and is called the ante- 
rior fossae of the basis of the cranium. 

2. The Middle Lobes are situated before and above 
the medulla oblongata, and rest on the middle fossae of 
the basis cranii, which are formed by the sphenoid and 
temporal bones. 

3. The Posterior Lobes are supported by the tento- 
rium. 

The anterior and middle lobes are parted by a deep 
narrow sulcus, which ascends obliquely backwards from 
the temporal ala of the os sphenoides to near the middle 



THE CEREBRUM. 



41 



of the os parietale ; it is termed Fissura Cerebri, or Fis- 
sura Magna Sylvii. 

By gently separating with the fingers the two hemi- 
spheres of the brain, 1 we see passing betwixt them a 

Fig. 8. 




Horizontal Section of the Cerebrum upon a Level with the Corpus 
Callosum. 

1. Outer edge of the Corpus Callosum, formed by pressing aside the 

Medullary Substance of the Hemisphere. 

2. Medullary or Fibrous Substance. 

3 Upper Surface of the Commissure. 
4. Raphe. 

[The fibres of the Corpus Callosum are erroneously represented in 
the cut — they should be shown as transverse instead of longitudinal.] 

longitudinal white convex body, the Corpus Callosum: 
it lies under the falx. On the surface of the corpus cal- 



1 Between the hemispheres and on the surface of the corpus callo- 
sum, we observe the arterise callosae, which are the continuation of the 
trunks of the anterior cerebri, 

4* 



42 PRACTICAL ANATOMY. 

losum is seen the Baphe, between two longitudinal 
medullary lines, Linea Longitudinalis Lancisii, united 
by transverse fibres, the Linea Transversa. 

When one hemisphere of the brain is cut horizontally 
on the level of the corpus callosum, an appearance is 
produced, termed the Centrum Ovale Minus. When 
both are sliced off to the same level, the Centrum Ovale 
Majus. 

Under this surface are the two lateral ventricles. 1 Tf 
one of these be cautiously perforated on the side of the 
corpus callosum, and gently inflated by a blowpipe, its 
extent may be seen ; but, if much force be used, the air 
will pass into the other ventricle. 

The two ventricles are separated by a medullary parti- 
tion, which descends from the inferior surface of the corpus 
callosum to the fornix, the Septum Lucidum ; it consists 
of two laminae, with a narrow cavity between the Fifth 
Ventricle. To see this septum, one of the ventricles 
must be laid open, and the septum pulled gently to the 
other side. 

The Lateral Ventricles are two, right and left, 
lined with a fine membrane, narrow, consisting of a body, 
and three prolongations or cornua. 

1. The body is formed betwixt the corpus callosum, 
the medulla of the brain, the convexity of the corpus 
striatum, and the thalamus nervi optici. 

2. The Anterior Cornu or horn is formed betwixt 
the more acute convexity of the corpus striatum, and the 
anterior part of the corpus callosum. 

3. The Posterior Cornu (called also the digital cavity) 
may be traced stretching backwards and downwards into 
the posterior lobe of the brain. 

4. The inferior or descending cornu cannot be traced 
in this stage of the dissection; it seems like the continued 
cavity of the ventricle, takes a curve backwards and out- 



1 To show the lateral ventricles, the corpus callosum should he cut 
away close to the septum lucidum, and then the ventricle of that body, 
and the thickness and breadth of the septum itself, will be more clearly 
seen. 






THE FORNIX. 48 

wards, and then, turning forwards, descends into the 
middle lobe of the brain. 

The lateral ventricles communicate with each other, 
and with the third ventricle, by an opening under the 
forepart of the arch of the fornix. 1 

In the lateral ventricles we meet with, 

The Fornix, a medullary body, flat and of a triangu- 
lar shape, broadest behind, which divides the two lateral 
and the third ventricles. It is exposed on tearing away 
the septum lucidum; its lower surface is towards the third 
ventricle; its lateral margins are in the lateral ventricles; 
on its upper surface it supports the septum lucidum, and 
under its most anterior part is the foramen Monroianum : 
— One of the angles of this body is forward, and the 
other two towards the back part: it rests chiefly on 
the thalami nervorum opticorum, but is separated from 
them by a vascular membrane called the velum inter- 
positum. 

The extremities of the body of the fornix are named 
its Crura. 

1. The crus anterius is double, bends downwards be- 
fore the anterior commissure of the brain, with which it 
is connected, and may be traced into the corpora albican- 
tia, and tuber cinereum on the base of brain. 

2. The two crura posteriory coalescing with the back 
part of the corpus callosum, pass, on each side, into the 
inferior cornu of the lateral ventricle, and terminate on 
the hippocampus major. 

Divide the body of the fornix, invert it, by turning the 
anterior crus forwards, and the posterior crura back- 
wards ; on the under surface of the latter is an appearance 

1 It lias been doubted whether or not this be an opening ; the choroid 
plexus passes through it, and seems to unite the surfaces ; it is ab- 
surdly named the Foramen Monroianum, from a mistaken notion that 
Dr. Munro discovered it, and may be seen by gently turning the ante- 
rior crus of the fornix to one side ; it is a space betwixt the most ante- 
rior part of the convexity of the thalami nervorum opticorum, and the 
anterior crus of the fornix. 

This foramen may always be easily found by following the course of 
the plexus choroides, as it passes forwards in the ventricle. It is a 
slit, rather than a round hole, in the natural state. 



44 



PRACTICAL ANATOMY. 



of transverse lines, named Corpus Psalloides, psalterium, 
or lyra. 

Fig. 9. 




A Transverse Section of the Brain, showing the Corpora Striata, 
Lateral Ventricles, and the Associated Parts. 



1,1. Medullary portion of the 9 
Hemispheres. 

2. Vesicular Neurine or Cortical 

Portion. 

3. Corpus Striatum. 

4. Septum Lucidum. 

5. Ventriculus Septi or Fifth 

Ventricle. 
6, 6. The Fornix. 

7. Posterior Crura of the Fornix. 

8. Base of the Fornix. 



9. Plexus Choroides, at the 
Margin of the Velum Inter- 
positum. 

10. Anterior Cornu of the Lateral 
Ventricle. 

11. Middle or Descending Cornu. 

12. Posterior Cornu. 

13. Hippocampus Major. 

14. Taenia Hippocampi. 

15. Hippocampus minor. 

16. Longitudinal Fissure of the 

Brain. 



The inversion of the fornix exposes 

The Plexts Chorotpes. — This is a continuation of 



VULVA. 45 

the pia mater, a spongy mass, consisting of folds of tor- 
tuous vessels partly covering the thalami nervorum 
opticorum, and continued into the inferior cornu of the 
lateral ventricles. The plexus of each side is connected 
to its fellow by the Velum Interpositum, a membrane 
which passes under the fornix, and lies on the third ven- 
tricle and corpora quadrigemina. 

From this plexus the blood is received by the Yena 
Galeni situated in the middle of the velum interpositum 
which consists of two parallel branches ; these run back- 
wards, unite, and enter the Torcular Herophili through 
the Sinus Eectus. 

This plexus should now be detached at its forepart, 
and turned back ; it will remain as a guide to the knife 
in tracing the inferior cornu of the lateral ventricle. 

We now see, 

The Corpora Striata, two smooth convexities, in the 
forepart of the lateral ventricle, broad, and rounded an- 
teriorty, becoming narrow, and diverging as they pass 
backwards, consisting of tubular and vesicular substance 
disposed in striae. 

The Thalami Nervorum Opticorum, two large oval 
whitish eminences, placed by the side of each other be- 
tween the diverging extremities or crura of the corpora 
striata; towards their forepart is a peculiar eminence or 
convexity, called the Anterior Tubercle. On the outer 
and posterior face two enlargements, the Corpus Ge- 
niculatum Externum and Internum. The former 
connected by a ridge to the testes. The latter to the 
nates. 

Taenia Semicircularis, a white medullary line, run- 
ning in the angle between the corpus striatum and thala- 
mus nervi optici of each side. 

Commissura anterior Cerebri, a short cylindrical 
medullary cord, stretched transversely between the fore 
and lower part of the corpora striata, immediately under 
the anterior crura of the fornix. 

Just above the commissura anterior, and before the 
thalami, is the Vulva, or foramen commune anterius, a 
small slit or indentation, formed by the anterior cms of 



46 PRACTICAL ANATOMY. 

the fornix, bifurcating, and inserting itself, on each side, 
between the corpus striatum and thalamus nervi optici. 
This slit is the space by which the three ventricles com- 
municate. 

Commissura Mollis is an exceedingly soft, broad, 
cineritious junction between the convex surfaces of the 
thalami nervorum opticorum. 

On separating the optic thalami, we discover the Third 
Ventricle. This is a longitudinal sulcus, or slit, situ- 
ated between the thalami nervorum opticorum, and be- 
tween the crura cerebri. Above, it is covered by the 
fornix and velum interpositum ; at its upper and fore- 
part, it communicates with, the two lateral ventricles ; be- 
low the commissura anterior, it opens into the infundibu- 
lum. This opening is termed Iter ad Infundibulum. 
Backwards, it is continued by a canal which passes under 
the tubercula quadrigemina into the fourth ventricle. 
This passage is named Iter ad Quartum VentriCulum 
(aquasductus Sylvii). 

The Pineal Gland, a small, soft, grayish, and conical 
body, of the size of a pea, is seated above the tubercula 
quadrigemina, and behind the thalami, to which it is con- 
nected by two white pedunculi, or footstalks ; its base is 
turned forwards, and the apex backwards ; it is covered 
by the plexus choroides and posterior crura of the fornix. 
It contains an earthy matter, either in its own substance 
or that of the pedunculi, resembling sand. It was named 
by Soemmering, who first discovered that it belongs to 
the healthy structure of the brain, the Acervulus Glan- 
dule PlNEALIS. 

Commissura Posterior, a transverse cord at the back 
part of the third ventricle, before the tubercula quadri- 
gemina, and above the iter ad quartum ventriculum. 

Tubercula Quadrigemina, four small white bodies, 
adhering together, lying under the pineal gland, behind 
the third ventricle, and above the fourth. The upper- 
most two are named Nates, and the other two Testes. 

From the under part of the testes, there project back- 
wards two ridges or cords, connecting themselves with 
the crura cerebelli, Processus a Cerebello ad Testes, 



THE CEREBELLUM. 
Fig. 10. 



47 




A Section op the Cerebrum, showing the Upper Surfaces of the Cor- 
pora Striata and Optic Thalami, the Cavity of the Third Ventricle, 
and the Upper Surfaces of the Cerebellum. 



a, e. Tubercula Quadrigemina. 

a. Nates. 
e. Testes. 

b. Commissura Mollis. 

e. Anterior Extremity of the 
Corpus Callosum cut. 

f. Crura of the Fornix. 

g. Anterior Horn of Lateral 

Ventricle. 
k, k. Corpora Striata. 
/, I. Thalami Optici. 
z to s. Third Ventricle. 



In Front of z is the Anterior 
Commissure. 
s. Posterior Commissure. 
p. Pineal Gland with its Pe- 
duncles. 
n,n. Processus e Cerebello ad 

Testes. 
m, m. Hemispheres of the Cere- 
bellum. 
h. Superior Vermiform Process. 
i. Notch between the Hemi- 
spheres of the Cerebellum 
behind. 



and a thin medullary lamina between the Valve of 

Vieussens. 



4:8 PRACTICAL ANATOMY. 

The inferior cornu of the lateral ventricle, which de- 
scends into the middle lobe of the brain, may now be 
traced, by following the tract of the choroid plexus. 1 In 
it is seen 

The Hippocampus Major, or Cornu Ammonis. At 
its commencement it is narrow, but it becomes a broad 
medullary projection of the floor of the ventricle; and 
its extremity, which is called Pes Hippocampi, is curved 
inwards. The thin edge on its inside, which follows the 
whole of its circuit, is named the Corpus Fimbriatum, 
or Taenia Hippocampi. Within this body is another, 
resembling the teeth of a comb, the Corpus Dentatum. 
The posterior crus of the fornix runs along its inner and 
anterior part, in the form of a thin floating edge. 

In the posterior cornu of the lateral ventricle, which 
passes into the posterior lobe of the brain, there is a 
similar medullary projection, but smaller, the Hippocam- 
pus Minor. 

Below the iter ad infundibulum, are seen the Corpora 
Albicantia Willisii (corpora mammillaria), two medul- 
lary eminences of the size of peas. The remainder of 
these bodies is seen on the outer surface of the base of 
the brain. 

This completes the demonstration of the cerebrum. 
The whole of the posterior lobes, and the lateral part of 
the middle lobes, may be removed. This exposes to your 
view 

The Tentorium and the Falx Cerebelli. At this 
point you should trace the bifurcation of the longitudinal 
sinus into the two lateral sinuses. The lateral sinuses are 
formed by the splitting of the laminae of the tentorium; 
hence they follow the course of that membrane, run 
along their grooves in the occipital bone, and dip down- 
wards and forwards through the foramen lacerum in basi 
cranii, to terminate in the internal jugular veins. 

The Torcular Herophili, or fourth sinus, runs along 
the middle of the tentorium, and joins the extremity of 
the longitudinal sinus at the point where it bifurcates. 

1 Or it may be exhibited by cutting away successive slices of the 
side of the brain until the ventricle is exposed. 



FOURTH VENTKICLE. 49 

The great notch of the tentorium is a circular opening 
left on the anterior part of the tentorium, allowing a junc- 
tion between the cerebrum and cerebellum. 

The brain should now be removed by elevating the 
front lobes, and dividing the nerves, arteries, &c, as they 
appear, cutting through the tentorium as it stretches along 
the Petrous bone, and, pushing the knife through the 
great occipital foramen, divide the spinal marrow and 
vertebral arteries, when it may be turned out and inverted. 
Clean it off well, leaving the nerves. Its under surface 
exhibits the Anterior and Middle lobes of the cere- 
brum, the two hemispheres of the cerebellum, the Pons 
Varolii, or Tuber Annulare, and Medulla Oblon- 
gata. 

Cerebellum. — This part of the brain, divided into two 
lobes by the falx cerebelli, or septum occipitale, is covered 
by a vascular membrane; consists of medullary and cine- 
ritious substance ; but, instead of convolutions, has nu- 
merous deep sulci, into which the pia mater dips, and 
forms thin flat strata. 

Kemark the following processes : — 

1. Appendix, or Processus Vermiformis Superior, 
situated under the pia mater, on the anterior and superior 
part of the cerebellum, the anterior part the Monticu- 
lus. 

2. Appendix, or Processus Vermiformis Inferior, 
will be found situated between the two lobes on the under 
surface of the cerebellum, and immediately behind the 
medulla oblongata. 

On separating the two lobes behind, and making a 
deep incision, we discover, 

The Fourth Yentricle. — The sides of this ventricle 
are formed by the cerebellum, the anterior part by the 
medulla oblongata, the upper and back part by the val- 
vula cerebri ; it is lined by a thin vascular membrane, 
and has on its forepart a groove or fissure, which, termi- 
nating in a sharp point, is named Calamus Scriptorius. 
On each side of this groove are seen several medullary 
lines, which are the origin of the portio mollis of the 
seventh pair of nerves. The iter a tertio ad quartum 
5 



50 



PRACTICAL ANATOMY. 




A Posterior View of the Cerebellum, and the several Lobules of 
which it is composed. (After Solly.) 



1. Spinal Cord. 

2. Posterior Spinal Nerves. 

3. Amygdaloid Lobule. 

4. Lobulus Pneumogastrici. 

5. Lobulus Gracilis. 

6. Inferior Semilunar Lobe. 



7. Superior Semilunar Lobule. 

8. Lobulus Quadratus. 

9. Superior Vermiform Process. 

10. Vermis Inferior. 

11. Monticulus. 



ventriculum enters the upper part of the fourth ventricle. 
The valve of Vieussens hangs over it. 

On cutting the cerebellum perpendicularly, there is 
formed, from the intermixture of cineritious and medul- 
lary matter, a tree-like appearance, named Arbor Vitje, 
of which the trunk is termed the peduncle of the cere- 
bellum, and is continued to the back part of the medulla 
oblongata. 

On the under surface is a gutter into which projects 
the Inferior Yermiform Process — the "Vallecula. 
This leads to the fourth ventricle, on each side of which 
and in the centre are lobes. The lateral ones called the 
Amygdala, the intermediate one the Uvula. Another 
on the restiform body, the Flocculus. 

Fissures of Sylvius — Separate the Anterior from 
the middle lobe of the cerebrum. 



THE MEDULLA OBLONGATA. 



51 



Fig. 12. 
Anterior Aspect of the Medulla Oblongata. 







1. Corpora Pyramidalia. 

2. The point of their Decussa- 

tion. 

3. Corpora Olivaria. 

4. Fibres that run from the An- 

terior Column of the Me- 
dulla Spinalis to the Cere- 
bellum. 

5. Corpora Restiformia. 

6. Arciform Fibres. 

7. Anterior Columns. 

8. Lateral Columns. 
1, 10. Pons Varolii. 

11. Roots of the Trigeminus 
Nerve. 



Medulla Oblongata — Upper end of the Medulla 
Spinalis. On it a median fissure ; three bodies on each 
side. One next to the fissure Corpus Pyramidale ; 
next the Olivarts, next the Eestiforme. 

Pons Varolii — The body at the top of the Medulla 
Oblongata. Basilar Artery rests upon its middle. 

Crura Cerebelli — Thick cords from the Pons to the 
cerebellum. 

Crura Cerebri — Bound cords passing in a divergent 
manner, from the Pons to the cerebrum. 

Corpora Mammillaria or Albicantia — Two little 
round bodies between the crura, front of the Pons. 

Locus Perforates — Perforated space between the 
last named bodies and the Pons. 

Tuber Cinereum or Pons Tarini — Triangular space 
in front of the corpora albicantia : a little process in its 
centre, the Infundibulum. In front the commissure of 
the optic nerves. 

Substantia Perforata — Perforated space at com- 
mencement of the fissure of Sylvius. 

Next examine the nerves. 



52 



PRACTICAL ANATOMY. 
Fig. 13. 




Base op the Brain. 



a. 


Forepart of the Longitudi- 
nal or Inter-Hemispheric 


?• 




Fissure. 


r. 


b. 


Notch between the Hemi- 


s, s. 




spheres of the Cerebellum. 


t. 


c. 


Optic Commissure. 


u, u. 


d. 


Left Cms Cerebri. 


V. 


e. 


Lobus Perforatus Lateralis. 


X. 


e to i. 


Inter-crural Lamina. 




ff> 


Convolution of the Fissure 


1. 




of Sylvius. 


2. 


i. 


Infundibulum. 


3. 


Z. 


Right Crus Cerebelli. 


4. 


m, m. 


Hemispheres of the Cerebel- 


5. 




lum. 


6. 


n. 


Eminentia Mammillaria. 


7. 


0. 


Pons Varolii, forming by its 


7. 




continuation on each side 


8. 




the Crus Cerebellum. 


8. 


V> 


Pons Tarini. 


8. 
9. 



A, Anterior, B, Middle, and C, Posterior Lobes 
of the Cerebrum. 



the 



Horizontal Fissure of 

Cerebellum. 
Gray Tuber. 
Fissure of Sylvius. 
Left Crus of the Cerebrum. 
Optic Tracts. 
Medulla Oblongata. 
Marginal Convolution of the 

Longitudinal Fissure. 
Olfactory Nerve. 
Optic. 

Motor Oculi. 

Trochlearis or Patheticus. 
Trigeminal or Trifacial. 
Motor Externus. 
Facial. 
Auditory. 
Glosso-Pharyngeal. 
Pneumogastric. 
Spinal Accessory. 
Hypoglossal. 



NERVES. 53 

1. The First Pair of Nerves, the Olfactory, arise 
from the outside of the corpora striata, between the ante- 
rior and middle lobe of the brain ; run under the anterior 
lobes, being lodged in two superficial grooves, and lying 
between the pia and dura mater ; expand into a small 
oval ganglion, from which several small filaments descend 
through the cribriform plate of the ethmoid bone, to 
ramify on the membrane lining the nose. 

2. The Second Pair, the Optic, arise from the poste- 
rior part of the optic thalami, and also from the tubercula 
quadrigemina; they make a circle round the crura cerebri 
called the Tr actus Opticus. The two nerves approach 
gradually, and unite, just before the pituitary gland, on 
the forepart of the sella turcica. They then diverge, 
and each nerve passes out at the foramen opticum of the 
sphenoid bone, to form the retina of the eye. 

On each side of these nerves are seen the Carotid 
Arteries. Each artery emerges from the cavernous 
sinus by the side of the anterior clinoid process : sends a 
branch forwards, which, uniting with a similar branch of 
the other carotid, forms the anterior part of the Circu- 
lus Arteriosus Willisii; while other branches, passing 
backwards, and uniting with branches of the basilar artery, 
complete the posterior part of the arterial circle. 

A fold of dura mater passes from the anterior to the 
posterior clinoid process of each side. This fold is 
double, and forms by its duplicative the Cavernous 
sinus. 

On dividing the optic nerves, and inverting them, we 
see the infundibulum, a funnel of cineritious substance, 
leading from the inferior and anterior extremity of the 
third ventricle to the pituitary gland; it is generally im- 
perforate before it reaches the gland. 

The Pituitary Gland, a reddish body somewhat 
globular, consisting of two lobes, is situated in the sella 
Turcica of the sphenoid bone, partly covered by a fold 
of dura mater, and attached to the infundibulum. The 
circular sinus is situated at this point. 

3. The Third Pair of Nerves, Motores Oculorum, 

5* 



54 PRACTICAL ANATOMY. 

arise from the crura cerebri, 1 pass outwards and forwards 
on the outer side of the posterior clinoid process into the 
cavernous sinus, and runniug through the foramen lace- 
rum orbitale superius of sphenoid bone to the muscles of 
the eye. 

Between these two nerves are seen the two vertebral 
arteries, ascending and uniting, to form the basilary artery. 

4. The Fourth Pair, Trochleares or Pathetici, 
are very slender, and situated immediately under the 
edge of the tentorium. This nerve arises from the valve 
of Vieussens, comes out from betwixt the cerebrum and 
cerebellum, passes by the side of the pons Varolii, and 
passing through the cavernous sinus, continues its course 
through the foramen lacerum orbitale superius, to supply 
the obliquus superior muscle of the eye. 

5. The Fifth Pair, Trigemini, are much larger than 
the fourth, and are situated more outwards and back- 
wards. Each of these nerves arises by a number of fila- 
ments, from the anterior and lowest part of the crus cere- 
belli, where the crus unites with the pons Varolii; it 
passes forwards, enters the cavernous sinus, where it un- 
twists itself, and forms a flat irregular ganglion, the 
Ganglion Gasserianum, and then divides into three 
great branches. 

(1.) Kamus Ocularis, or the Ophthalmic Nerve of 
Willis, passes through the foramen lacerum orbitale supe- 
rius to the appendages of the eye. 

(2.) Kamus Maxillaris Superior passes through the 
foramen rotundum to the upper jaw and face. 

(8.) Kamus Maxillaris Inferior passes through the 
foramen ovale to the lower jaw and tongue. 

6. The Sixth Pair, Motores Oculorum Externi, or 
abductores. — This nerve is small, but not so small as the 
fourth pair ; it is seen arising betwixt the pons Varolii 
and corpora pyramidalia. It enters the cavernous sinus; 

1 The two crura pass obliquely backwards and inwards, so as to 
converge and meet in front of the tuber annulare ; it is from the hol- 
low formed by their convergence, and named by Vicq d'Azyr, /bs.se des 
nerfs oculo-mwiciilaires, that the third pair arise. 



NERVES. 55 

it there runs by the side of the carotid artery, and passes 
through the foramen lacerum orbitale superius to the 
rectus externus oculi. 

7. The Seventh Pair. Nervi Auditorii, consists of 
two portions. 

(1.) The Portio Dura, or the facial nerve, arises from 
the crus cerebelli, aud comes out from the fossa or groove 
betwixt the pons Yarolii, corpora olivaria, and crura cere- 
belli. 

(2.) The Portio Mollis, or more properly the auditory 
nerve, arises from the inner surface of the fourth ventri- 
cle. It has a groove on its surface for receiving the 
portio dura ; accompanied by an artery, they enter the 
meatus auditorius internus, where the portio mollis is 
distributed to the parts of the internal ear, while the 
portio dura runs through the aqueduct of Fallopius, and 
comes out at the stylo-mastoid foramen below the ear, to 
form the principal nerve of the face. 

8. The Eighth Pair consists of three, the Par Yasnim, 
Spinal Accessory, and Glosso-Pharyngeal. The Par 
Yagum arises by numerous filaments from the sides of the 
corpora olivaria and medulla oblongata. They unite, run 
towards the foramen lacerum in basi cranii, pierce the 
dura mater, and pass out through the anterior part of the 
hole, having been first joined by the 

Nervus Accessorius, which runs up from the medulla 
spinalis through the great occipital foramen, and then 
separate to their different destinations. 

The great Lateral Sinus passes out by the back part 
of the same foramen, to form the internal jugular vein ; 
it is separated from the nerve by a slip of cartilage. 

9. The Ninth Pair, Linguales or Hypoglossal. — 
This nerve arises from the furrow betwixt the corpora 
olivaria and pyramidalia, by several filaments, which 
often pierce the dura mater separately. It passes through 
the anterior condyloid hole of the occipital bone to sup- 
ply the muscles of the tongue. 

Immediately after leaving the cranium, the eighth and 
ninth pair, and the ganglion of the sympathetic are con- 
nected together. 



56 PRACTICAL ANATOMY. 



VESSELS OF THE BRAIN. 



Internal carotid enters the skull through the carotid 
foramen in the temporal bone; passing through the 
cavernous sinus it divides into the following branches: — 

1. Anterior Cerebri, passing between the anterior 
cerebral lobes. 

2. Media Cerebri, in the fissure of Sylvius. 

3. Artebia Communicans, passing back to unite with 
the Basilar. 

Vertebral Atery — From the subclavian ascends 
through the foramina of the cervical transverse processes, 
enters the foramen magnum, and gives branches to the 
dura mater and medulla spinalis, then 

1. Infekior Cerebellar to under part of cerebellum. 
The union of the two vertebral form the 

2. Basilar, which rests on the pons Varolii. 

3. Superior Cerebellar to upper part of cerebellum. 

4. Posterior Cerebral to the posterior lobes of the 
cerebrum. With this usually the communicating branch 
from the carotid unites to form the circle of Willis. 

The veins open into the sinuses, and they into the in- 
terna I jugu lar vein. 

Medulla Spinalis, or the Spinal Marrow. This part 
of the nervous or sensorial system must be here de- 
scribed, although its dissection cannot be performed till 
all the muscles of the back are removed, so that the pos- 
terior part of the spinal canal may be sawed off. 

The spinal canal is lined by a strong ligamentous 
sheath, and the dura mater is continued down upon this 
sheath in the form of a funnel. 

The spinal marrow consists externally of medullary 
substance, internally of vesicular. It runs down to the 
first lumbar vertebra, where it terminates by numerous 
filaments, which form the Cauda Equina. It is closely 
embraced by the pia mater, while the tunica arachnoides 
adheres to that membrane very loosely. During the 
whole of its passage, there is on each side a membranous 
connection between the pia and dura mater, by distinct 



SPINAL NERVES. 



57 



slips, irregular and pointed, which connection is named 
Ligamentum Denticulatum. This ligament separates 
the two roots of the spinal nerves. The arteries of the 
medulla may be seen running down on its anterior and 
posterior surfaces; they are branches of the vertebral 



Fig. 14. 
Fissures or Sulci of the Spinal Marrow. 



1. Anterior Longitudinal Fis- 

sure. 

2. Posterior Longitudinal Fis- 

sure. 

3. Antero-Lateral Fissure, for 

the Corresponding Roots of 
the Spinal Nerves. 

4. Postero-Lateral Fissure, for 

the Posterior Roots of the 
Spinal Nerves. 

5. Lateral Fissure. 




irtery; and on these surfaces the Anterior and Poste- 
rior Median or Longitudinal Fissure, dividing it into 



Fig. 15. 
Origin of the Spinal Nerves. 
I 2 1 



L , 1 . Lateral Columns , mark- 
ed off in front at (2) 
the Anterior Fissure. 

3. Anterior Roots. 

4. Posterior Roots. 

5. Ganglion formed by the 

Posterior Roots. 

6. Spinal Nerve, formed 

by the junction of the 

Anterior and Posterior 

Roots. 
Anterior Branch of the 

Spinal Nerve. 
Posterior Branch. 



7. 




58 PRACTICAL ANATOMY. 

lateral columns. Each column is again divided into three 
others by two lateral lines, the points where the roots of 
the spinal nerves come out. The cord has two enlarge- 
ments upon it, the upper corresponding to the origin of 
the brachial plexus, the lower to the lumbar nerves. 

The spinal accessory nerve is seen arising by small 
twigs from the posterior bundles of the fourth, fifth, sixth, 
and seventh cervical nerves; it then ascends along the 
spinal canal, enters the foramen, and passes forwards, to 
accompany the par vagum. 

The spinal marrow sends off thirty pair of spinal nerves, 
which pass through the foramina formed between the 
bodies of the vertebra. They consist of eight cervical, 
twelve dorsal, five lumbar, and five or six sacral pairs of 
nerves. Each of these nerves arises in two fasciculi or 
roots, one from the forepart, the other from the back part 
of the spinal cord. These fasciculi penetrate the dura 
mater separately. On the posterior bundle or root is a 
ganglion. 



CHAPTER Y. 
DISSECTION OF THE ANTERIOR PART OF THE NECK. 

OF THE MUSCLES. 

The utility of this dissection must be evident, when 
you consider how many important parts are contained in 
the forepart of the neck. The tube which conveys air 
to the lungs, the vessels which are sent from the heart to 
the brain, and the nerves which are destined to supply 
the thoracic and abdominal viscera, are situated in the 
neck ; and all these parts lie embedded in cellular sub- 
stance ; hence the dissection is intricate, and requires the 
utmost care in its performance. 

The muscles of the anterior part of the neck are six- 



SUPERFICIALIS COLLI. 59 

teen in number on each side. They may be divided into 
muscles situated superficially, muscles at the upper part 
of the neck, and those situated at the lower part. To 
dissect the neck, make one incision from the top of the 
sternum to the symphysis of the chin, a second along the 
base of the jaw to the mastoid portion of the temporal 
bone, and a third from the sternum along the clavicle to 
the acromion process of the scapula. Keflect the integu- 
ments. 

The superficial muscles are two. 

Immediately under the integments, and adhering to 
them. 

1. The Musculus Cutaneus, vulgo, Platysma myoides 
— Will be found to be between two layers of the super- 
ficial fascia of the neck; the fascia extends over face and 
parotid gland. It arises, by slender separate fleshy fibres, 
from the cellular substance, covering the upper part of 
the deltoid and pectoral muscles. These fibres form a 
thin broad muscle, which runs obliquely upwards, and is 

Inserted into the skin and muscles covering the lower 
jaw and cheek. This muscle should be dissected in the 
course of its fibres ; the skin, therefore, must be dissected 
off in an oblique direction from the clavicle to the chin. 

Use : To draw the skin of the cheek downwards, and, 
when the mouth is shut, to draw the skin under the lower 
jaw upwards. 

Eemove the platysma myoides from its origin, and in- 
vert it over the face. Immediately beneath it is seen the 
external jugular vein, which is formed of branches from 
the temple, side of the face, and throat. It crosses ob- 
liquely over the sterno-mastoideus, passes behind the 
outer edge of that muscle, and plunges beneath the clavi- 
cle, to enter the subclavian vein. 

If the platysma has been carefully lifted several nerves 
may be exhibited in its deep surface. One towards the 
angle of the jaw. 

Superficialis Colli. — One to the ear just behind the 
jugular vein, the Auricularis Magnus ; one along the 
posterior border of the S. cleido-mastoid muscle to the 
back of the head, the Occipitalis Minor ; other branches 



60 PRACTICAL ANATOMY. 

descend ; some of which are deep for the supply of mus- 
cles. All these are from the Supeeficial Cervical 
Plexus, which comes out just behind the middle of the 
sterno-cleido-mastoid muscle, and is formed by the ante- 
rior branches of the three or four upper spinal nerves. 

The strong fascia seen covering the muscles of the 
neck after the removal of the Platysma. It forms sheaths 
for the muscles of the neck by detaching from its deep sur- 
face septa which pass in between them. It is attached be- 
hind to the spinous processes of the cervical vertebrae under 
the trapezius muscle ; above to the base of the jaw as it 

Fig. 16. 




1. Platysma Myodes Muscle. 

2. Scattered Fibres of the same, forming the Musculus Risorius of 

Santorini. 

3. Sterno-Cleido-Mastoid Muscle. 

4. Trapezius. 

5. Splenius. 

6. Posterior Large Triangle of the Neck, bounded in front by the 

Sterno-Cleido-Mastoid, behind by the Trapezius, and below by 
the Clavicle. 



MUSCLES. 61 

passes to the face, and at its angle dips down to the styloid 
process, forming the Stylo-Maxillary Ligament, and 
forming as will be seen again a complete separation be- 
tween the Parotid and Submaxillary Glands. Along 
the middle line of the neck it meets the fascia of the oppo- 
site side, encasing muscles and thyroid gland; below it is 
attached both to the top and inner surface of the sternum, 
to the sternal end of the clavicle, to the cartilage oF the 
first rib, and is connected to the sheaths of the bloodvessels 
and nerves as they pass into the axilla. 

2. The Sterno-Cleido-Mastoideus — Arises by two 
distinct origins; the anterior, tendinous and fleshy, and 
somewhat round, from the top of the sternum, near its 
junction with the clavicle ; the posterior or outer, fleshy 
and flat, from the upper and anterior part of the clavicle. 
These two origins soon unite, and form a strong muscle, 
which ascends obliquely upwards and outwards, to be 

Inserted, tendinous, into the outside of the mastoid pro- 
cess, and into the transverse ridge behind that process. 

Use: When one acts singly, it turns the head to one 
side. When both act together, they bend the head for- 
wards. 

The muscle should be detached from the sternum and 
clavicle, and left suspended by its insertion. It is pierced 
by several branches of the cervical nerves, and, about its 
middle, it is perforated by the Nervus Accessorius. These 
nerves ramify on the neighboring . muscles of the neck 
and shoulder. Between the posterior edge of the sterno- 
cleido-mastoideus and the forepart of the trapezius mus- 
cles, above the clavicle, is seen a quantity of loose fatty 
substance, intermixed with branches of nerves. This 
fatty substance is watery and granulated; it must not be 
removed roughly, lest important nerves and vessels be 
injured; it is continued around the vessels under the 
clavicle. 

In the middle of the throat you see, 

(1.) The Os Hyoides, or bone of the tongue, forming 
the uppermost of the projections beneath the chin. 

(2.) The Larynx, or upper part of the trachea, con- 
sisting of five cartilages, of which two are evident ex- 



62 PKACTICAL ANATOMY. 

ternally, viz: 1. The uppermost and largest is the thy- 
roid cartilage; 2. The inferior is the cricoid cartilage. 
The two arytenoid cartilages, and the epiglottis, lie behind 
this. 

(8.) The Trachea, consisting of cartilaginous rings, and 
extending into the thorax. 

(4.) Behind the larynx is situated the pharynx. At 
the part where the larynx terminates in the trachea, the 
pharynx contracts itself, and forms the oesophagus, or 
muscular tube, conveying the food to the stomach, which 
descends behind the trachea, situated rather to the left 
side of the cervical vertebras. 

These parts are covered by muscles; and on each side 
of the trachea lie the great vessels and nerves. 

Muscles at the lower part of the neck are five. 

3. The Sterno-Hyoideus — Arises, thin and fleshy, 
from the upper and inner part of the sternum, clavicle, 
and first rib ; it forms a flat and narrow muscle. 

Inserted into the base of the os hyoides. 

Situation: This pair of muscles is seen on removing 
the platysma myoides, between the sterno-cleido mas- 
toidei. 

Use : To pull the os hyoides downwards. 

4. The Omo-Hyoideus, inclosed in lamina of the deep 
fascia — Arises, broad, thin, and fleshy, from the root of 
the coracoid process, and semilunar notch of the scapula, 
ascends across the neck, and forms a middle tendon, where 
it passes below the sterno-cleido-mastoideus. Becoming 
fleshy again, it runs up, and is 

Inserted into the base of the os hyoides, between its 
cornu and the insertion of the sterno-hyoideus. 

Situation: The lower part of this muscle is covered by 
the trapezius; its middle by the sterno-cleido-mastoideus; 
its anterior part is seen on removing the platysma my- 
oides ; it crosses over the carotid artery and internal jugu- 
lar vein. 

Use: To pull the os Iryoides obliquely downwards. 

5. The Sterno- Thyroid eus. — This muscle arises, 
fleshy, from the inside of the sternum, and of the ex- 
tremity of the first rib ; forms a flat muscle, and is 



DIGASTRICUS, 63 

Inserted into the inferior edge of the oblique ridge on 
the ala or side of the thyroid cartilage. 

Situation: Beneath the sterno-hyoideus. 

Use: To draw the thyroid cartilage, and consequently 
the larynx, downwards. 

Under the sterno-thyroideus we find situated the 

Thyroid Gland, a large reddish mass, situated on the 
superior rings of the trachea, below the cricoid cartilage; 
in form somewhat like a crescent, with the cornua turned 
upwards. 

6. The Thyro-Hyoideus — Arises, fleshy, from the 
upper surface of the oblique ridge in the ala of the thy- 
roid cartilage, and passes upwards, to be 

Inserted into part of the base, and almost all the cornu 
of the os hyoides. 

Use: To pull the os hyoides downwards, or the thyroid 
cartilage upwards. 

Situation: Concealed by the sterno-hyoideus. 

7. The Crico-Thyroideus — Arises, tendinous and 
fleshy, from the side and forepart of the cricoid cartilage, 
and runs obliquely upwards. 

Inserted, by two fleshy portions, the first into the lower 
part of the thyroid cartilage, and the second into its infe- 
rior cornu. 

Situation: On the side of the larynx, and under the 
sterno-thyroideus. 

Use: To pull forwards and depress the thyroid, or to 
elevate and draw backwards the cricoid cartilage. 

The muscles at the upper part of the neck consist of 
nine pairs. 

8. The Digastricus — Arises, principally fleshy, from 
the fossa at the root of the mastoid process of the tem- 
poral bone ; its fleshy belly terminates in a strong round 
tendon, which runs downwards and forwards, passes 
through the fleshy belly of the stylo-hyoideus, is fixed 
by strong ligamentous and tendinous fibres to the os 
hyoideus, from which it receives an addition of fibres ; it 
then becomes again fleshy, and runs obliquely upwards, 
to be 



64 



PKACTl CAL ANATOMY. 




Lateral View of the Neck, with the Skin, Platysma, and Cervical 
Fascia removed. 



a, a. Sternal ends of the Clavicles. 

b. Upper part of the Sternum. 

c. Third portion of the Subcla- 
vian Artery. 

Primitive Carotid Artery di- 
viding into the internal and 
external Carotids. 

e. Posterior Scapular Artery. 

/. Transverse Cervical or Supra- 
scapular Artery. 

g. Brachial Plexus of Nerves. 

h. Trapezius Muscle. 

i. Tendon of the Omo-hyoid 
Muscle. 



d. 



k. Anterior belly of the Omo- 
hyoid. 

L Sterno-Cleido-Mastoid Mus- 
cle. 
m. Sterno-hyoid Muscles. 

n. Larynx. 

o. Parotid Gland. 

p. Submaxillary (Hand. 

q. Posterior Belly of the Digas- 
tric Muscle. 

r. Anterior Belly of the same. 

s. Stylo-hyoid Muscle. 

t. Hyoid Bone. 



Inserted into a rough sinuosity on the anterior inferior 
edge of that part of the lower jaw called the Chin. 
Situation: Its posterior belly is covered by the sterno- 



STYLO-PHARYNGEUS. 65 

cleido-mastoideus; its anterior belly lies immediately 
under the skin and platysma myoides. 

Use: To open the mouth, by pulling the lower jaw 
downwards and backwards ; and, when the jaws are shut, 
to raise the larynx, and consequently the pharynx up- 
wards, as in deglutition. 

In the triangular space formed by the two bellies of 
this muscle, and the base of the lower jaw, lies the Sub- 
maxillary Gland. It lies upon a flat muscle, the mylo- 
hyoideus, which is seen between the two bellies of the 
digastricus ; the gland is surrounded by little absorbent 
glands, and is encased in a pocket of deep fascia. 

9. The Stylo-Hyoideus — Arises, tendinous, from the 
middle and inferior part of the styloid process of the tem- 
poral bone; its fleshy belly is generally perforated by 
the digastricus. 

Inserted, tendinous, into the os hyoideus at the juncture 
of its base and cornu. 

Situation: The origin of this muscle is situated more 
inwards than the last; it is the most superficial of three 
muscles which arise from the styloid process ; sometimes 
it is accompanied by another small muscle, having the 
same origin and insertion, the stylo-hyoides alter. 

Use: To pull the os hyoides to one side, and a little 
upwards. 

10. The Stylo-Glossus — Arises, tendinous and fleshy, 
from the styloid process, and from a ligament that con- 
nects that process to the angle of the lower jaw. It de- 
scends, and becomes broader, but less thick. 

Inserted into the root of the tongue, runs along its side, 
and is insensibly lost near its tip. 

Situation: This muscle lies within and rather above 
the stylo-hyoideus ; underneath it is a ligament, extend- 
ing from the styloid process to the angle of the os hy- 
oides. Ligamentous fibres are also seen passing from 
that process to the inside of the angle of the lower jaw, 
Stylo-Maxillary Ligament. 

Use: To move. the tongue laterally and backwards. 

11. The Stylo-Pharyngeus — Arises, fleshy, from the 
root and inner part of the styloid process. 

6* 



66 PRACTICAL ANATOMY. 

Inserted into the side of the pharynx and back part of 
the thyroid cartilage. 

Situation : It is situated deeper, and behind the stylo- 
glossus. 

Use: To dilate and raise the pharynx and thyroid car- 
tilage upwards. 

On removing the submaxillary glands, and detaching 
the digastric muscle from the os hyoides and chin, we ex- 
pose the next muscle ; but should notice in its removal 
the facial artery which runs through it on its way to the 
face, giving to it the Submaxillary Branches, and one 
which runs along the jaw towards the chin, the Sub- 
mental. 

12. The Mylo-Hyoideus — Arises, fleshy, from all the 
inside of the lower jaw, between the last dens molaris 
and the middle of the chin ; the fibres form a flat muscle, 
converge, and are 

Inserted into the lower edge of the base of the os hy- 
oides. 

Situation: This muscle unites with its fellow in a mid- 
dle tendinous line which extends from the os hyoides to 
the chin ; its posterior part is lined by the internal mem- 
brane of the mouth ; it lies under the digastricus, but is 
seen betwixt its bellies. 

Use: To pull the os hyoides forwards, upwards, and to 
either side. 

The submaxillary gland sends off a duct, which passes 
behind the posterior edge of the mylo-hyoideus, and runs 
along the inner surface of this muscle forwards and up- 
wards, on the inside of the sublingual gland, to open into 
the mouth on the side of the frenum of the tongue. 
Above it will be seen the Lingual Branch of the infe- 
rior maxillary nerve. 

The Sublingual Gland lies immediately above the 
mylo-hyoideus, betwixt it and the internal membrane of 
the mouth, where it lines the side and inferior surface of 
the tongue. It sends off several ducts, which open into 
the mouth between the root of the tongue and side of the 
lower jaw. 



GENIO-HYO-GLOSSUS. 



67 



The removal of the mylo-hyoideus exposes a pair of 
muscles, which are closely attached to one another. 

13. The Genio-Hyoideus — Arises, tendinous, from a 
projection on the inside of that part of the lower jaw 
which is called the Chin ; it descends, becoming broader, 
and is 

Inserted into the basis of the os hyoides. 

Use: To draw the os hyoides forwards and upwards to 
the chin. 




Muscles of the Tongue. 



1. Stylo-glossus. 

2. Stylo-hyoideus. 

3. Lingualis. 

4. Dorsum of the Tongue. 
6. Hyo-glossus. 



7. Genio-hyo-glossus. 

8. Stylo-pharyngeus. 

9. Genio-hyoideus. 

10. Raphe of the Mylo-hyoideus. 

11. Digastricus. 



By removing this muscle, or turning it back from its 
origin from the jaw, we discover the next muscle. 

14. The Genio-Hyo-Glossus — Arises, tendinous, from 
a rough protuberance on the inside of the lower jaw, 
higher up than the origin of the genio-hyoideus ; its fibres 



68 PRACTICAL ANATOMY. 

run forwards, upwards, and backwards, in a very wide 
and radiated manner, to be 

Inserted, some into the posterior part of the base of the 
os hyoides, near its cormi, others into the tip, middle, and 
root of the tongue. 

Situation: This muscle lies under the genio-hyoideus 
before, and more outwardly under the mylo-hyoideus. 

Use: According to the direction of its fibres, to draw 
the tip of the tongue backwards into the mouth, the mid- 
dle downwards, and to render its dorsum concave ; to 
draw its root and the os hyoides forwards, and to thrust 
the tongue out of the mouth. 

15. The Hyo-Glossus — Arises, broad and fleshy, from 
half of the base, and part of the cornu of the os hyoides; 
the fibres run upwards, to be 

Inserted into the inside of the tongue. Be careful here 
of the Hypoglossal Nerve, and Lingual Artery, to be 
presently described. 

Situation: It is situated more outwardly than the genio- 
hyo-glossus, and, at its insertion into the tongue, mixes 
with the stylo-glossus. 

Use: To move the tongue inwards and downwards. 

16. The Lingualis — Arises, from the root of the tongue 
laterally, and runs forwards between the hyo-glossus and 
genio-hyo-glossus, to be 

Inserted into the tip of the tongue, along with part of 
the stylo-glossus. 

Use: To contract the substance of the tongue, and 
bring it backwards. 

OF THE VESSELS AND NERVES SEEN IN THE DISSECTION 
OF THE NECK. 

Arteries. 

The Carotid Artery ascends from the thorax by the 
side of the trachea ; on its outer side it has the internal 
jugular vein and the par vagum, and behind the sympa- 
thetic nerves. All these parts are connected and inclosed 
by condensed cellular membrane, which forms a kind of 



FASCIALIS. 09 

sheath for containing them. At the bottom, and in the 
middle of the neck, the carotid is covered by the sterno- 
cleido-mastoideus ; at the upper part, by adipose mem- 
brane, absorbent glands, and by the platysma myoides. 
It lies deep on the muscles of the spine, and gives off no 
branches, until it reaches the space between the larynx 
and angle of the jaw, just below the cornu of the os 
hyoides, where it divides into the external and internal 
carotids. 

Of the two, the internal carotid is situated most out- 
wardly ; it passes deep to the base of the cranium, where 
it enters the foramen caroticum, to supply the brain. 

The external carotid immediately begins to send off 
branches. 

Anteriorly it sends off, 

1. The A. Thyroidea Superior. — This artery passes 
downwards and forwards, to ramify on the thyroid gland, 
where it inosculates with the artery of the other side, 
and with the inferior thyroid arteries. In this course, it 
sends ramifications to the integuments, the outside of the 
larynx, the muscles, &c, and one remarkable branch, the 
A. Laryngea, which sometimes arises from the trunk of 
the external carotid ; it is a small artery which divides 
betwixt the os hyoides and thyroides cartilages, to supply 
the internal parts of the larynx. 

2. A. Lingua lis. — This artery passes over the cornu 
of the os hyoides, then parallel with it, covered by the 
stylo-glossus, hyo-glossus, and genio-hyo-glossus, to which 
it gives branches, and terminates in running along the 
inferior part of the tongue from its base to its apex. It 
gives branches to the muscles about the chin, and to 
the substance and back part of the tongue. 

3. A. Fascialis. — The external maxillary artery 
passes under the stylo-hyoideus and posterior belly of 
the digastricus, then buries itself under the submaxillary 
gland. It runs over the lower jaw before the anterior 
edge of the masseter muscle, to supply the face. 

In its passage, it gives off numerous branches. One is 
worthy of notice, which runs along under the line of the 
lower jaw, 



70 PRACTICAL ANATOMY. 

The Submental, and passing over the jaw near the 
symphysis, supplies the chin. Other twigs supply the 
submaxillary gland, &c. 

Posteriorly the carotid sends off 

4. A. Occipitalis. — The occipital artery crosses back- 
wards and upwards, over the internal jugular vein and 
internal carotid artery, under the belly of the digastric 
muscle ; it passes through a slight groove in the mastoid 
process, below its great fossa, and ramifies on the back 
part of the head. A remarkable branch of the occipital 
passes towards the base of the skull, to inosculate near 
the foramen magnum occipitis, with branches from the 
vertebral and posterior cervical arteries. 

5. A. Pharyngea is a small branch of the carotid, 
which passes inwards to the pharynx and base of the 
skull. 

6. Posterior Auris, which passes backwards and up- 
wards in the fold, between the ear and scalp, and is dis- 
tributed on the integuments of the head. 

The external carotid ascends behind the angle of the 
jaw, and enters the parotid gland, where it divides into, 

7. A. Maxillaris Interna. 

8. A. Temporalis. 

9. A. Trans versalis Faciei. 

These arteries are described in the dissection of the 
face. 

Veins. 

The Internal Jugular Vein is a continuation of 
the lateral sinus which passes through the foramen lace- 
rum in the base of the cranium. It comes out deep from 
under the angle of the jaw, and in its course down the 
neck, it runs on the outer side of the carotid artery, be- 
fore it reaches the thorax ; it passes rather more forwards 
than the artery, to join the subclavian vein. 

Its branches accompany the ramifications of the ex- 
ternal carotid. At first the vein which accompanies each 
artery is a single branch, but it soon subdivides, so that 
two veins accompany one artery. 



NERVUS LARYNGEUS SUPERIOR. 71 



Nerves. 

1. The Eighth Pair, or Par Vagum. — On separating 
the internal jugular vein, and trunk of the carotid artery, 
the par vagum is seen lying in the same sheath of cellu- 
lar substance with those vessels. It lies in the triangular 
space formed betwixt the back part of the artery and 
vein, and the subjacent muscles. This nerve comes out 
of the foramen lacerum with the jugular vein; hence it 
adheres to that vein more closely than to the artery or 
muscles ; it runs down the neck behind these vessels. 

In this course it gives off several nerves. 

(1.) At the base of the cranium it sends off several 
filaments, which are connected with the other nerves 
corning out of the base of the skull, such as the ninth 
pair, the superior cervical ganglion of the sympathetic, 
&c. 

(2.) Nervus Glosso-Pharyngeus leaves the other 
branches of the eighth pair, deep under the angle of the 
jaw. It passes behind the carotids towards the muscles 
arising from the styloid process ; one principal branch of 
it passes between the stylo-pharyngeus and stylo-glossus 
to the tongue, while other twigs run behind the stylo- 
pharyngeus, to supply the pharynx. 

(3.) Nervus Laryngeus Superior. — The superior or 
internal laryngeal nerve passes behind the internal carotid 
artery, obliquely, downwards and forwards ; then, under 
the hyo-thyroideus muscle, it plunges betwixt the os 
hyoides and thyroid cartilage, accompanying the laryn- 
geal artery, and supplying the internal parts of the 
larynx. 

(4.) In the neck, also, the par vagum gives off fila- 
ments to the cervical ganglions of the sympathetic nerve, 
and communicates with the other nerves of the neck. 
Filaments also unite with twigs of the sympathetic, and 
run down over the carotid artery to the great vessels of 
the heart, where they form the superior cardiac plexus. 

The par vagum enters the thorax by passing betwixt 
the subclavian artery and vein. 



72 



PRACTICAL ANATOMY. 



17 



Fig. 19. 
Nerves of the Neck and Tongue. 

1. Part of the Temporal Bone. 

2. Stylohyoid Muscle. 

3. Stylo-glossus Muscle. 

4. Stylo-pharyngeus Muscle. 

5. Tongue. 

6. Hyoglossus Muscle. 

7. Genio-hyoglossus Muscle. 
9. Sterno-hyoid Muscle. 

10. Sterno-thyroid Muscle. 

11. Thyro-hyoid Muscle, upon 
which is seen a branch of 
the Hypoglossal Nerve. 

12. Omo-hyoid Muscle straight- 
ened by the removal of 
the Loop of Cervical Fas- 
cia through which its 
tendon plays. 

13. Common Carotid Artery. 

14. Internal Jugular Vein. 

15. External Carotid Artery. 

16. Internal Carotid. 
Gustatory Branch of the 

Fifth Nerve, giving a 
Branch to (18) the sub- 
maxillary Ganglion. 

19. Duct of Submaxillary Gland. 

20. Glosso-pharyngeal Nerve. 

21. Hypoglossal Nerve. 

22. Descending Branch from the Cervical Plexus. 

23. Communicating Branch from the Cervical Plexus. 

24. Pneumogastric Nerve emerging from between the Internal Jugular 

Vein and Common Carotid Artery to enter the Chest. 

25. Facial Nerve, emerging from the Stylo-mastoid Foramen, and cross- 

ing the External Carotid Artery. 

2. The Intercostal, or Great Sympathetic Nerve. 
— This nerve lies behind the carotid, in the cellular mem- 
brane, betwixt that vessel and the muscles covering the 
vertebrae of the neck. It is distinguished from the par 
vagum by being smaller, lying nearer the trachea, and 
adhering to the muscles of the spine ; also by its forming- 
several ganglions. It comes out by the same foramen as 
the carotid artery. 

Immediately after its exit from the skull, it forms the 
Superior Cervical Ganglion, which is very long, and 




BRANCHES. 73 

of a reddish color. The nerve afterwards becomes 
smaller, and descends ; and opposite the fifth or sixth cer- 
vical vertebra, it forms another swelling, the Inferior 
Cervical Ganglion. Sometimes it has another gan- 
glion about the fourth or fifth vertebra of the neck, the 
Middle Cervical Ganglion : but this is not a constant 
appearance. The nerve then passes behind the subcla- 
vian artery into the thorax. 

The branches of the intercostal nerve are numerous, 
and they generally pass off from the ganglions. Imme- 
diately below the base of the cranium, twigs go to the 
eighth and ninth pairs, and to the upper cervical nerves. 
In the middle of the neck, some twigs pass over the 
carotid ; others go to the parts covering the trachea, uniting 
with filaments of the par vagum ; others unite with the 
descenders noni, or descending branch of the ninth pair, 
and some filaments assist the twigs of the par vagum to 
form the superior cardiac nerve. In the lower part of 
the neck, twigs are sent to communicate with the cervical 
nerves, &c. 

3. The Ninth Pair, Nervus Hypoglossus, or Lingual 
Nerve, having left the skull by the anterior condyloid 
foramen, is connected with the eighth pair and sympa- 
thetic nerve. Like them, it lies deep, and comes out from 
under the angle of the jaw. It is seen passing from be- 
hind the internal jugular vein, and then over the carotid 
artery, running betwixt these two vessels. It next passes 
under the mylo-hyoideus, running over the stylo-glossus, 
hyo-glossus, and geniohyo-glossus, which last muscle its 
numerous branches perforate. 

4. Branches. — While the nerve is passing betwixt the 
jugular vein and the carotid artery, it sends off' the 
Descendens Noni. — This small and delicate nerve de- 
scends on the forepart of the vein and artery, and is 
distributed to the muscles on the anterior part of the 
trachea. It is joined by a filament formed by the first, 
second, and third cervical nerves, the Communicans 
Noni. 

The Lingual Branch sent off by the third branch of 
the fifth pair of nerves, is also seen in the dissection of 
7 



74 



PRACTICAL ANATOMY. 




Cervical and Brachial Plexuses op Nerves or the Right Side. 

1. Facial Nerve. 

2. Pneumogastric Nerve. 

3. Internal Carotid Artery. 

4. Spinal Accessory Nerve. 

5. Anastomoses of the Spinal Accessory Nerve with the Cer- 

vical Plexus. 

6. Hypoglossal Nerve, giving off its Descending Branch. 



PHRENIC NERVE. 75 

7. Anterior Branch of the first Cervical Nerve, Anastomosing 

with the Hypoglossal Nerve and with the Pnenmogastric. 

8. Descending Cervical Branch of the Cervical Plexus, Anas- 

tomosing with the corresponding Branch of the Hypo- 
glossal. 

9. Phrenic Nerve. 

10, 10. Deep Cervical Branches of the Cervical Plexus. 

11. Brachial Plexus. 

12. Branch to the Subclavian Muscle, sending a Filament to 

the Phrenic Nerve. 

13. Anterior Thoracic Branches. 

14. Lateral Thoracic Branch, or the Branch to the Great Serrate 

Muscle. 
15, 16, 17. Subscapular Branches going to the Subscapular, Latissi- 
mus, and Greater Teres Muscles. 

18. Axillary Artery, surrounded by a sort of Sheath, formed 

by Branches going to the Arm. 

19. Brachial Branches. 

the neck. It is found under the mylo-hyoideus ; it lies 
close upon the lower edge of the jaw-bone, betwixt the 
inferior edge of the pterygoid eus intern us and the upper 
part of the mylo-hyoideus. It gives numerous twigs to 
the sublingual gland and submaxillary duct, which are 
situated near it, and is lost in the substance of the tongue. 

5. Nervus Accessorius ad par Yagum, one of the 
eighth pair. — The accessory nerve, having passed out of 
the cranium with the par vagum, separates from it, 
passes behind the internal jugular vein obliquely down- 
wards and backward ; it perforates the mastoid muscle, 
and is distributed to the trapezius and muscles about the 
shoulder ; it is much connected with the third and fourth 
cervical nerves. 

6. The Seven Cervical Nerves come out from the 
foramina betwixt the vertebrae of the neck. They send 
numerous branches to the muscles, &c, on the side of the 
neck, and communicate by filaments with all the other 
nerves in the neck. 

In this stage of the dissection we may also see, 

7. The Phrenic Nerve, formed by branches of the 
third and fourth cervical nerves. This small nerve lies 
upon the belly of the Scalenus Anticus Muscle, and 
passes into the thorax, betwixt the subclavian artery 
and vein. 



76 PRACTICAL ANATOMY. 

8. Recurrent Nerve. — From the par vagum in the 
thorax, lying close alongside the trachea as it ascends. 

9. Brachial Plexus. — Seen between the Scaleni 
Muscles, formed by four lower cervical, and first dorsal 
spinal nerves, passes into the axilla to become the axillary 
plexus. 

ARTERIES. 

Subclavian Artery on the right side is a branch of 
the Innominata, on the left it is derived from the Aorta; 
on the right side it passes by a gentle curve to the sca- 
lenus anticus muscle, and rests upon the pleura. This 
first part on the left side rises almost perpendicularly up 
out of the chest, and has the pleura in front. Both after 
this pass beneath the scalenus anticus, having the bra- 
chial plexus of nerves and the scalenus posticus to the 
outer and posterior side, thence over the first rib, after 
which they become Axillary Arteries. 

Thyroid Axis — A stem which generally furnishes 

1. Inferior Thyroid Artery, which passes under 
the carotid bloodvessels to the thyroid gland. 

2. Superficialis Cervicis — distributed to the deep 
layer of muscles front of spine. 

3. Supra Scapular — following the course of the cla- 
vicle, it supplies the muscles on the dorsum of the sca- 
pula. 

4. Posterior Scapular — across the neck, along the 
posterior border of the scapula — supplies the muscles on 
that portion of the scapula. 

Profunda Cervicis — passes back between the trans- 
verse processes of last cervical and first dorsal vertebrae ; 
it sends a branch up to inosculate with the Princeps 
Cervicis from the Occipital Artery. 

Backwards, the subclavian sends off 

The Vertebral Artery. — This artery arises from 
the back part of the subclavian, passes outwards, and 
enters the foramen in the transverse process of the last 
cervical vertebra, and ascends through the transverse 
process of the vertebrae, to enter the foramen magnum of 
the occipital bone. 



ARTERIES. 
Fig. 21. 



77 




Arteries of the Neck. 



1. Heart. 

2. Left Coronary Artery. 

3. Right Coronary Artery. 

4. Pulmonary Artery cut through. 

5. Arch of the Aorta. 

6. Innominata Artery. 

7. Right Primitive Carotid. 

8. Left Subclavian. 



9. Division of the Innominata 
into the Right Primitive Ca- 
rotid and Right Subclavian. 

10. Division of the Primitive Ca- 

rotid into External and In- 
ternal Carotid. 

11. Superior Thyroid Artery. 

12. Lingual Artery. 



78 



PRACTICAL ANATOMY. 



13. Facial or External Maxillary 

Artery. 

14. Inferior Palatine Artery. 

15. Submental Artery. 

16. Inferior Labial Artery. 

17. Superior Labial Artery. 

18. Lateral Nasal Branch. 

19. Occipital Artery. 

20. Posterior Auricular Artery. 

21 . Ascending Pharyngeal Artery. 

22. Division of the External Ca- 

rotid into Temporal and In- 
ternal Maxillary Artery. 

23. Transverse Facial Artery. 

24. Temporal Artery. 

25. Middle or Deep Temporal Ar- 

tery. 
25'. Inferior Thyroid Artery. 

26. Vertebral Artery. 

27. Point at which the Vertebral 



Artery enters the opening in 
the Transverse Process of the 
Sixth Cervical Vertebra. 

28. Left Superior Intercostal Ar- 

tery. 

29. Transverse Cervical Artery. 

30. Posterior Scapular Artery. 

31. Internal Mammary Artery. 

32. Mediastinal Branch. 

33. Superior Phrenic Artery. 

34. 35. Anterior Temporal Artery. 
36. Posterior Temporal. 

87. Trachea. 

38. Middle Thyroid Artery, an 

anomalous branch of the 
aorta sometimes met with. 

39. Thyroid Body. 

40. Ascending Cervical Artery, a 

branch of the Inferior Thy- 
roid. 



Anteriorly, the subclavian artery gives off, 

5. A. Mammaria Interna. — The internal mammary 
arises from the forepart of the subclavian opposite the 
cartilage of the first rib ; it runs down on the inside of 
the cartilages of the ribs, and terminates in the abdominal 
muscles, where it inosculates with the epigastric. It is a 
large artery, and its branches are very numerous. They 
pass to the external muscles of the chest, to the intercos- 
tal muscles, pleura, &c. It also sends off the Arteria 
Phrenica Superior, vel comes nervi phrenici, which, 
with two veins, accompanies the phrenic nerve to the 
diaphragm. 

6. The subclavian artery gives twigs to the root of the 
neck, and to the muscles about the scapula. 

7. A. Intercostalis Superior. — Frequently a trunk 
comes off from the subclavian, especially on the right 
side, which passes downwards and backwards, and lodges 
itself by the spine, to supply the two or three superior 
intercostal spaces. 

Course of the Subclavian Vein, 

The Subclavian Vein is situated anteriorly to the sub- 
clavian artery; it passes inwards behind and under the 



NERVES. 79 

subclavius muscle, and before and over the belly of the 
anterior scalenus (so that this last muscle lies betwixt the 
vein and artery). It runs over the first rib, where it is 
found in contact with the axillary artery, and is called 
the Axillary Yein. 

The branches of this vein accompany and correspond 
to the ramifications of the subclavian artery, returning 
the blood from the thyroid gland, neck, chest, intercostal 
spaces, &c. The subclavian vein also receives the inter- 
nal jugular, which passes down behind the clavicle. 

The Course of the Brachial Plexus of Nerves 

May also be examined. This plexus is formed by 
branches of the four lower cervical and first dorsal nerves, 
which pass between the anterior and middle scaleni 
muscles into the axilla. In this passage they are situated 
higher up than the artery. 

A considerable part of the scaleni muscles may now be 
seen, covered by a strong fascia, the Prevertebral 
Fascia ; the upper insertion of these muscles must be 
dissected with the muscles of the back part of the neck. 

1. The Scalenus Anticus — Arises, by three tendons, 
from the transverse processes of the fourth, fifth, and 
sixth vertebrae of the neck. 

Inserted, tendinous and fleshy, into the upper edge of 
the first rib, near its cartilage. 

2. The Scalenus Medius — Arises, tendinous, from the 
transverse processes of all the vertebrae of the neck. 

Inserted into the upper and outer part of the first rib, 
from its root to within the distance of half an inch from 
the scalenus anticus. 

3. The Scalenus Posticus — Arises, tendinous, from 
the transverse processes of the first and sixth vertebrae of 
the neck. 

Inserted into the upper edge of the first rib, near the 
spine. 

Situation: These muscles are covered before by the 
sterno-mastoideus and trapezius, behind by the trapezius 
and levator scapulae ; but the scaleni are so connected 



80 



PRACTICAL ANATOMY. 



with the muscles of the spine that the whole of them 
cannot be demonstrated till the muscles of the back and 
neck are dissected. 

Uses of these three muscles : to bend the neck to one 
side, and, when the muscles of both sides act to bend it 
forwards ; or, when the neck is fixed, to elevate the ribs, 
and dilate the chest. 

Fig. 22. 




Cervical Muscles. 



1. Basilar Process of the Occi- 

pital Bone. 

2. Mastoid Process. 

3. Rectus Capitis Anticus Ma- 

jor. 

4. Rectus Capitis Anticus Minor. 

5. Rectus Capitis Lateralis. 

6. Longus Colli, right side. 

7. Same, left side. 

8. Scalenus Posticus. 

9. Scalenus Anticus. 



10. First Rib. 

11. Passage of the Subclavian 

Artery. 

12. Second Rib. 

13. Third Dorsal Vertebra. 

14. Transverse Process of the 

Atlas. 

15. First Inter-trans versalis Mus- 

cle. 

16. Sixth Inter-transversalis Mus- 

cle. 



CERVICAL VERTEBRA. 81 

Dissection of the Muscles on the front of the Cervical Vertebrce. 

These muscles maybe exposed by raising off the muscles 
already dissected, together with the trachea, larynx, and 
oesophagus. There are four pairs. 

1. Longus Colli — Arises, tendinous and fleshy, from 
the sides of the bodies of the three cervical vertebrae, and 
from the anterior surface of the transverse processes of 
the four or five lower cervical vertebrae. 

Inserted, tendinous and fleshy, into the forepart of the 
bodies of all the vertebrae of the neck. . 

Situation : This muscle lies behind the oesophagus and 
great vessels and nerves of the neck. 

Use : to bend the neck forwards and to one side. 

2. Kectus Capitis Anticus Major — Arises, tendinous 
and fleshy, from the anterior points of the transverse 
processes of the third, fourth, fifth, and sixth cervical 
vertebrae. 

Inserted into the cuneiform process of the os occipitis 
in front of the condyloid process. 

Situation : Further out than the longus colli. 
Use : To bend the head forward. 

3. Kectus Capitis Anticus Minor — Arises, fleshy, 
from the forepart of the body of the first vertebra of the 
neck, close to the transverse process, and ascending ob- 
liquely, is 

Inserted near the root of the condyloid process of the 
occipital bone, under the last muscle : acts as the last. 

4. Kectus Capitis Lateralis — Arises, fleshy, from 
the upper part of the transverse process of the atlas. 

Inserted, tendinous and fleshy, into the transverse ridge 
of the os occipitis. 

Situation: it is immediately behind the internal jugu- 
lar vein, where it comes out from the cranium. 

Use: draws the head somewhat to one side. 



82 PRACTICAL ANATOMY. 



CHAPTEK VI. 

DISSECTION OF THE THROAT. 

On looking into the mouth, we observe the tongue, 
and a soft curtain hanging from the palate bones, named 
the Velum Pendulum Palati, or soft Palate. The 
apex of the velum forms a small projecting body, 
termed the Uvula, or pap of the throat. From each 
side of the uvula, two muscular half-arches or columns 
are sent down, the anterior to the root of the tongue, the 
posterior to the side of the pharynx. Between these half- 
arches on each side are situated the glands termed Amyg- 
dalae, or Tonsils. The common opening behind the ante- 
rior arch is named the Fauces, or top of the Throat, from 
which there are six passages, two upwards, being one to 
each nostril, called the Posterior Nostrils; two at the 
sides, called Eustachian Tubes, passing on each side to 
the ear; 1 two downwards, of which the anterior is the 
passage through the glottis and larynx into the trachea ; 
the posterior, which is the largest, is the pharynx, or top 
of the oesophagus, and leads to the stomach. 

MUSCLES SITUATED ABOUT THE ENTRY OF THE FAUCES. 

These consist of four pairs, and a single muscle in the 
middle. 

1. Constrictor Isthmi Faucium — Arises, by a slen- 
der beginning, from the side of the tongue, near its root ; 
thence running upwards within the anterior arch, before 
the amygdala, it is 

Inserted into the middle of the velum pendulum palati, 

1 A probe may be introduced through the anterior nostrils into the 
Eustachian tube ; the tube opens into the pharynx in a direction op- 
posite to the space between the roots of the middle and inferior tur- 
binated bones. 



MUSCLES. 



83 




Fig. 23. 
The Pharynx laid open and viewed from behind. 



1. A Section carried transversely 
through the Base of the Skull. 

2, 2. The Walls of the Pharynx drawn to 

each side. 

3, 3. The Posterior Nares, separated by 

the Vomer. 

4. The Extremity of the Eustachian 

Tube of one side. 

5. The Soft Palate. 

6. The Posterior Pillar of the Soft Pa- 

late. 

7. Its Anterior Pillar; the Tonsil is 

seen in the niche between the 
two Pillars. 

8. The Root of the Tongue, partly con- 

cealed by the Uvula. 

9. The Epiglottis, overhanging (10) the 

Superior opening of the Larynx. 

11. The Posterior Part of the Larynx. 

12. The Opening into the (Esophagus. 

13. The External Surface of the (Eso- 

phagus. 

14. The Trachea. 



as far as the root of the uvula. It is here connected with 
its fellow, and with the beginning of the palato-pharyn- 
geus. 

Situation: It forms the anterior half-arch. 

Use: To draw the velum towards the root of the tongue, 
which at the same time it raises, and, with its fellow, to 
contract the opening into the fauces. 

2. The Palato-Pharyngeus — Arises, by a broad be- 
ginning, from the root of the uvula in the middle of the 
velum pendulum palati, and from the tendinous expan- 
sion of the circumflexus palati. The fibres pass along 
the posterior arch behind the amygdalae, and run back- 
wards to the superior and lateral part of the pharynx, 
where they are scattered, and mixed with those of the 
stylo-pharyngeus. 

Inserted into the edge of the upper and back part of 
the thyroid cartilage, and into the back part of the pha- 
rynx. 

Situation : It forms the posterior half-arch or column. 



84 PRACTICAL ANATOMY. 

Use: To draw the uvula and velum downwards and 
backwards, and pull the thyroid cartilage and pharynx 
upwards ; to shut the passage into the nostrils, and, in 
swallowing, to thrust the food from the fauces into the 
pharynx. 

3. The Circumflexus, or Tensor Palati— Arises from 
the spinous process of the sphenoid bone, behind the 
foramen ovale, and from the Eustachian tube near its 
osseous part; runs down along the pterygoideus internus, 
and forms a round tendon, which passes over the hook of 
the internal plate of the pterygoid process of the sphenoid 
bone, and soon spreads into a broad tendinous expansion. 

Inserted into the velum pendulum palati, and semilunar 
edge of the os palati. 

Situation: Its insertion extends as far as the suture 
which joins the two ossa palati. Some of its posterior 
fibres generally join with the constrictor pharyngis supe- 
rior and palato-pharyngeus. 

Use- To stretch the velum, to draw it downwards, and 
to one side. 

4. The Levator Palati — Arises, tendinous and fleshy, 
from the extremity of the petrous portion of the temporal 
bone, and from the Eustachian tube. 

Inserted into the whole length of the velum pendulum 
palati, as far as the root of the uvula, uniting with its 
fellow. 

Use : To draw the velum upwards and backwards, so 
as to shut the passage from the fauces into the mouth and 
nose. 

Azygos Uvul^]. — There are two which arise, fleshy, 
from the extremity of the suture which unites the ossa 
palati ; runs down the whole length of the velum, like a 
small earth-worm, adhering to the tendons of the circum- 
flexi palati. 

Inserted into the tip of the uvula. 

Use : To raise the uvula upwards and forwards, and 
shorten it. 



MUSCLES. 85 

The Tongue. 

The tongue is connected by its root to the os hyoides, 
is principally formed by muscular structure. On its 
surface note its roughness, formed by papillae, eight or 
nine at its posterior part, arranged in a V-shaped figure 
(Papilla Maxima). Smaller and more numerous are 
others scattered over the tongue (the Papillae Mediae). 
A third class, very numerous (the Papillae Minimis, or 
Filiformes). Three folds of mucous membrane pass 
from the back part of the tongue to the sides and centre 
of the Epiglottis (Glosso-Epiglottidean Folds), the 
middle ones sometimes called the Fr^num of the Epi- 
glottis. The Foramen Caecum of Morgagni is in front 
of this. 

Muscles. 

Several of the muscles of the tongue have been de- 
scribed in the dissection of the neck. Those which enter 
into its structure proper are the 

Lingualis, which arises from its root, and runs as far 
as the tip. 

Use : To shorten the tongue. 

SUPERFICIALIS LlNGU^E, TRANSVERSALES LlNGUJE, and 

Verticales Linguje. — Their names indicate their di- 
rection. 



MUSCLES SITUATED ON THE POSTERIOR PART OF THE 
PHARYNX. 

Of these there are three pair, and are better dissected 
after the muscles on the back of the neck are disposed of, 
in order to remove the head from its articulation with 
the atlas, taking with it the Pharynx, Larynx, and (Eso- 
phagus. 

1. The Constrictor Pharyngis Inferior. — This 
muscle arises from the outside of the ala of the thyroid 
cartilage, near the attachment of the thyreo-hyoideus 
muscle, and from the side of the cricoid cartilage, near 
the crico-thyroideus. 



86 PRACTICAL ANATOMY. 

Inserted into the white line on the back part of the 
pharynx, where it is united to its fellow. 

Situation: This muscle covers the under part of the 
middle constrictor ; the superior fibres run obliquely up- 
wards, while the inferior fibres have a transverse direction. 

Use : To compress that part of the pharynx which it 
covers, and to raise it with the larynx a little upwards. 

2. The Constrictor Pharyngts Medius — Arises from 
the superior edge of the cornu of the os hyoides, extending 
as far forwards as the appendix ; and from the ligament 
which connects it to the thyroid cartilage. The superior 
fibres ascend obliquely, the others run more transversely. 

Inserted into the cuneiform process of the os occipitis, 
before the foramen magnum, and into a white line in the 
middle of the posterior surface of the pharynx, where it 
is joined to its fellow. 

Situation : The lower part of this muscle is covered by 
the muscle last described, while the upper part covers the 
inferior fibres of the constrictor superior. 

Use: To compress that part of the pharynx which it 
invests, and to draw it and the os hyoides upwards. 

3. Constrictor Pharyngis Superior — Arises } above, 
from the cuneiform process of the os occipitis, before the 
foramen magnum ; lower down, from the pterygoid pro- 
cess of the sphenoid bone ; from the upper and under jaw, 
near the alveolar processes of the last dentes molares ; 
and from the back part of the buccinator muscle. Some 
fibres also come from the root of the tongue, and from 
the palate. 

Inserted into a white line in the middle of the posterior 
surface of the pharynx. 

Situation: The larger part of this muscle is covered 
by the constrictor medius. 

Use: To compress the upper part of the pharynx, and 
draw it forwards and upwards. 

MUSCLES OF THE LARYNX. 

The Larynx is composed of five cartilages: 1. The 
Thyroid Cartilage, situated immediately below the os 



MUSCLES OF THE LARYNX. 



87 



Fig. 24. 
A Side View of the Muscles of the Pharynx. 




1. The Trachea. 

2. The Cricoid Cartilage. 

3. The Crico-thyroid Ligament. 

4. The Thyroid Cartilage. 

5. The Thyro-hyoid Ligament. 

6. The Hyoid Bone. 

7. The Stylo-hyoid Ligament. 

8. The (Esophagus. 

9. The Inferior Constrictor Muscle. 

10. The Middle Constrictor Muscle. 

11. The Superior Constrictor Muscle. 

12. The Stylo-pharyngeus Muscle 

passing down between the Su- 
perior and Middle Constrictors. 

13. The Upper Concave Border of 

the Superior Constrictor. At 
this point the - muscular fibres 
of the Pharynx are deficient. 

14. The Pterygo-Maxillary Liga- 

ment. 

15. The Buccinator Muscle. 

16. The Orbicularis Oris Muscle. 

17. The Mylo-hyoid Muscle. 



hyoides in the middle of the throat. 2. The Cricoid 
Cartilage, situated immediately below the thyroid car- 
tilage, betwixt it and the superior rings of the trachea. 
3. The Epiglottis, a broad triangular cartilage, very 
elastic, situated behind the root of the tongue, and co- 
vering the entrance into the upper part of the larynx. 
4 and 5. The arytenoid cartilages, two small bodies, like 
peas, situated behind the thyroid cartilage, on the upper 
edge of the back part of the cricoid cartilage, and be- 
tween the two ake or wings of the thyroid cartilage. 
These two small cartilages form betwixt themselves and 
the thyroid a longitudinal fissure, extending from before 
backwards, which is called the Glottis, or Eima Grlottidis, 
and leads to the trachea. 

The muscles situated about the glottis consist of four 
pair of small muscles, and a single one. 

1. TheCRico-ARYT^ENOiDEUs Posticus — Arises, fleshy, 
from the posterior part of the cricoid cartilage, and is 



88 



PRACTICAL ANATOMY, 



Fig. 25. 
Cartilages op the Larynx separated and seen in Front. 



1 to 4. Thyroid Cartilage. 

1. Vertical Ridge, commonly called 

Adam's Apple, formed by the 
union of the two Plates or 
Halves. 

2. Right Half. 

3. Superior, and 

4. Inferior Horn of the Right Side. 
5, 6. Cricoid Cartilage. 

7. Right Arytenoid Cartilage. 




Inserted, narrow, into the back part of the arytenoid 
cartilage of the same side. 

Use: To open the rima glottidis a little, and, by pulling 
back the arytenoid cartilage, to render the ligament of 
the glottis tense. 

2. The Crico-Arytjenoideus Lateralis — Arises, 
fleshy, from the side of the cricoid cartilage, where it is 
covered by the ala of the thyroid cartilage. 

Inserted into the outer side of the arytenoid cartilage. 

Situation : It lies more forward than the last described 
muscle. 

Use : To open the rima glottidis, by pulling the liga- 
ments from each other. 

3. The Thyreo-Aryt^noiueus— Arises from the mid- 
dle and inferior part of the posterior surface of the thy- 
roid cartilage; runs backwards, and a little upwards, and is 

Inserted into the forepart of the arytenoid cartilage. 

Situation: It is situated more forwards than the muscle 
last described. 

Use: To pull the arytenoid cartilage forwards, and 
thus shorten the ligament of the larynx or glottis. 



LARYNGEAL MUSCLES. 



89 



Fig. 26. 
Laryngeal Muscles. 



1. Epiglottis. 

2. Thyroid Cartilage. 

3. Cricoid Cartilage. 

4. Crico-arytenoideus Posticus. 

5. Arytenoideus Transversa. 

6. Arytenoideus Obliquus. 




Arytenoideus Obliquus — Arises from the base of 
one arytenoid cartilage ; and, crossing its fellow, is 
Inserted into the tip of the other arytenoid cartilage. 

Fig. 27. 
Muscles and Cartilages of the Larynx. 



1. Epiglottis. 

2. Cricoid Cartilage. 

3. Thyroid Cartilage. 

4. Crico-arytenoideus Lateralis. 

5. Thyro-arytenoideus. 




Use : When both act, they pull the arytenoid cartilages 
towards each other. 

The single muscle is the 

Arytenoideus Transversus, which arises from the 

8* 



90 PKACTICAL ANATOMY. 

whole length of one arytenoid cartilage, and passes across, 
to be 

Inserted into the whole length of the other arytenoid 
cartilage. 

Situation: It is situated anterior to the arytaenoidei 
obi i qui. 

Use : To shut the rima glottidis, by bringing the aryte- 
noid cartilages together. 

On each side of the larynx, there are also a few mus- 
cular fibres, which are named as follows : — 

1. Thyreo-Epiglottideus — Arising, by a few pale 
separated fibres, from the thyroid cartilage, and 

Inserted into the epiglottis laterally. 

Use : To draw the epiglottis obliquely downwards, or, 
when both muscles act, directly downwards ; and at the 
same time to expand it. 

2. The Aryt^no-Epiglottideus — Arises, by a few 
slender fibres, from the lateral and upper part of the 
arytenoid cartilage, and is 

Inserted into the epiglottis, along with the former 
muscle. 

Use: When both muscles act, to pull the epiglottis 
close upon the glottis. 

The Thyreo-Hyoideus and the Crico-Thyroideus were 
described with the muscles of the neck. The inside of 
the larynx is lined with a mucous membrane, and two 
folds will be seen running from the arytenoid cartilages 
to the angle of the thyroid ; on either side these are the 
Vocal Cords. Between the cords of each side a cavity 
(the Ventricle), which communicates with another cavity 
at the upper and front part (the Sac of Hilton, or Sac- 
culus Laryngis). The cavity above the upper cords 
(the glottis) ; space between the lower cords, the Rima 
Glottidis. 



MUSCLES SITUATED WITHIN THE ORBIT. 91 



CHAPTER VII. 
DISSECTION OF THE ORBIT OF THE EYE. 

The globe or ball of the eye is situated about the 
middle of the orbit. It is connected to the bone by its 
muscles, and by the optic nerve ; and all these parts are 
embedded posteriorly in a soft, fatty substance, which 
fills up the bottom of the orbit. The tunica, or mem- 
brana conjunctiva, is seen lining the inner surface of the 
eyelids, and reflected from them over the anterior part of 
the globe of the eye, so that the back part of the eyeball, 
and all the muscles and nerves, are situated behind it. 
This membrane must therefore be dissected away, the 
upper part of the orbit, which is formed by the os fron- 
tis, removed with a saw, and the fat surrounding the 
muscles, vessels, and nerves, cautiously dissected away 
with the scissors. 

MUSCLES SITUATED WITHIN THE ORBIT. 

Seven muscles are contained within the orbit, of which 
one belongs to the upper eyelid, and six to the globe of 
the eye. 

1. The Levator Palpebr^e Supekioris — Arises, by 
a small tendon, from the upper part of the forameft opti- 
cum of the sphenoid bone ; the tendon forms a broad 
flat belly. 

Inserted, by a broad thin tendon, into the upper eyelid, 
adhering to the tarsal cartilage, which gives form to the 
eyelid. 

Use: To open the eye, by drawing the superior eyelid 
upwards. 

There are four straight muscles, or recti, belonsrins: to 
the globe of the eye. These four muscles resemble each 



92 PRACTICAL ANATOMY. 

other, all arising by narrow tendons from the margin of | 
the foramen opticum, where they surround the optic 
nerve ; all forming strong fleshy bellies, and inserted, by 
broad, thin tendons, at the forepart of the globe of the 
eye, into the tunica sclerotica, or outer tunic of the eye, 
and under the tunica conjunctiva. 

2. The Levator Oculi, or Eectus Superior — Arises, 
by a narrow tendon, from the upper part of the foramen 
opticum of the sphenoid bone ; it forms a fleshy belly, 
and is 

Inserted into the superior and anterior part of the 
tunica sclerotica, by a broad thin tendon. 

Situation: It lies below the levator palpebrse supe- 
rioris. 

Use : To raise the globe of the eye. 

3. The Depressor Oculi, or Eectus Inferior — Arises 
from the inferior margin of the foramen opticum, and is 

Inserted into the inferior and anterior part of the tunica 
sclerotica. 

Use: To move the globe of the eye downwards. 

4. The Adductor Oculi, or Eectus Interims — Arises 
from the inner part of the foramen opticum, and is 

Inserted into the inner and anterior part of the tunica 
sclerotica. 

It is the shortest of the four recti muscles. 
Use: To draw the eye towards the nose. 

5. The Abductor Oculi, or Eectus Externus — Arises 
from the outer part of the foramen opticum. 

Inserted into the outer part of the tunica sclerotica. 

Itis the longest of the recti. 

Use: To move the globe outwards. 

The two next are oblique muscles. 

6. The Obliquus Superior, or Trochlearis — Arises, 
by a small tendon, from the margin of the foramen opti- 
cum, between the levator and abductor oculi. Its long 
slender belly runs along the inner side of the orbit to the 
internal angular process of the os frontis, where a car- 
tilaginous pulley is fixed. The muscle then forms a ten- 
don, which passes through the pulley, runs obliquely 



MUSCLES OF THE EYEBALL. 



93 



downwards and outwards, inclosed in a membranous 
sheath ; and, becoming broader and thinner, is 

Inserted into the tunica sclerotica, about half way be- 

Fig. 28. 




A Side View of the Muscles of the Eyeball. 



A. Ball of the Eye. 

1. Levator Palpebrse Superioris. 

2. Obliquus Superior, or Trochlea- 

ris Muscle. 

3. Trochlea of the last-named Mus- 

cle. 

4. Rectus Superior Muscle. 

5. Rectus Inferior Muscle. 

6. Rectus Externus Muscle. 



7. Ligament of Zinn. 

8. Origin of the Superior Oblique 

Muscle. 

9. Origin of the Rectus Externus. 

10. Obliquns Inferior Muscle. 

11. Optic Nerve. 

12. Malar Bone, divided. 

13. Upper Maxillary Bone. 



tween the insertion of the levator oculi and the entrance 
of the optic nerve. 

Use: To roll the globe of the eye, and turn the pupil 
downwards and outwards. 

7. The Obliquus Inferior — Arises, narrow, and prin- 
cipally tendinous, from the outer edge of the orbitar pro- 
cess of the superior maxillary bone, near its junction 
with the os unguis. It runs obliquely outwards and 
backwards, under the depressor oculi, and is 



94 PRACTICAL ANATOMY. 

Inserted, by a broad thin tendon, into the sclerotica, 
between the entrance of the optic nerve and the insertion 
of the abductor oculi. 

Use: To draw the globe of the eye forwards, inwards, 
and downwards, and to turn the pupil upwards. 

In the orbit we also meet with the Lachrymal Gland. 
This gland is of a yellowish color; it is situated in a de- 
pression of the os frontis near the temple. It adheres 
closely to the fat which surrounds the muscles and pos- 
terior convexity of the eye. It sends off several small 
ducts, which pierce the tunica conjunctiva lining the 
upper eyelid ; these ducts cannot be seen, unless the part 
be macerated in water, when they are filled with the 
liquid. 

The Palpebr^e, or Eyelids, are two cartilaginous 
plates, semilunar in form, the upper the largest, connect- 
ed to the internal and external angle of the orbit by 
fibrous tissue called the external and internal palpebral 
ligament (the internal one sometimes called the Tendo 
Oculi), above and below to the periosteal margin of the 
orbit, by a fibrous membrane. 

The Puncta Lachrymalia are two small holes near 
the internal angle of the palpebrae, situated one in each 
eyelid. They lead into the Lachrymal Ducts, the ducts 
into the lachrymal sac. 

The Lachrymal Sac is an oblong membranous bag, 
situated at the inner angle of the eye, in a depression 
formed by the os unguis, and nasal process of the supe- 
rior maxillary bone. It receives the tears by the puncta 
lachrymalia, and from the sac they are conveyed into the 
nose by a Duct, named the Lachrymal, or Nasal. The 
lower extremity of this duct opens into the nose on one 
side of the antrum maxillare, and under the os spongio- 
sum inferius. A probe, with its extremity bent, may be 
introduced from the nose through this duct into the lach- 
rymal sac. 

The Caruncula Lachrymalis is a small reddish granu- 
lated body, situated at the internal angle of the palpebra?. 

Tensor Tarsi of Horner — Arises from the posterior 
superior surface of the os unguis, passes forwards and 



ARTERIES. — VEINS. — NERVES. 95 

outwards, lying on the posterior face of the lacrimal 
ducts, upon which it is inserted nearly as far as the 
pun eta lachrymalia. 

Use: Draws the ducts towards the eye. 

OF THE VESSELS AND NERVES MET WITH IN THE ORBIT OF 
THE EYE. 

Arteries. 

The Ophthalmic, or Ocular Artery, is a branch of 
the internal carotid. It enters the orbit from the basis of 
the cranium by the foramen opticum. It gives branches 
to the lachrymal gland, fat, muscle, and globe of the eye. 
One twig, named the A. Centralis Eetin^e, enters the 
substance of the optic nerve, and is continued on to the re- 
tina ; twigs also pass to the eyelids, and to the inner angle 
of the eye. The Arteria Frontalis is a branch of this 
artery ; it is seen running towards the supra-orbitary 
notch or foramen, and is distributed to the forehead. 

The Infra-Orbitary Artery is found in the lower 
part of the orbit ; it is the continued trunk of the internal 
maxillary, entering the orbit by the spheno-maxillary slit. 
It is seen passing along the canal in the upper part of the 
great tuberosity of the os maxillare superius, and emerges 
on the face by the infra- orbitary hole. 

Veins. 

These correspond with the arteries; they discharge 
their blood partly into the branches of the external jugu- 
lar vein near the forehead and temples, and partly into 
the internal jugular. 

Nerves. 

1. The Optic Nerve is seen coming through the fora- 
men opticum, and entering the back part of the globe of 
the eye, to form the retina. 

2. The Nerve of the Third Pair, Motor Oculi, having 
entered the orbit through the superior orbitary fissure, or 
foramen lacerum, is divided into four branches. 



96 PRACTICAL ANATOMY. 

(1.) The first runs upwards, and subdivides into two 
nerves, of which, one supplies the superior rectus, and the 
other the levator palpebra? superioris. 

(2.) The second branch goes to the superior rectus, and 
is short. 

(3.) The third branch supplies the obliquus inferior, 
and also gives off a twig, which assists in forming the 
lenticular ganglion. 

(4.) The fourth branch supplies the internal rectus. 

3. The nerve of the Fourth Pair, N. Patheticus, or 
Trochlearis, enters the orbit by the superior orbitary fis- 
sure, and runs to the obliquus superior. 

4. The first branch of the Nerve of the Fifth Pair, 
named Ophthalmic, or Orbitary, enters the orbit by the 
superior orbitary fissure, and divides into three branches. 

(1.) The Frontal, Supra-orbitary, or Superciliary 
Nerve, accompanies the frontal artery along the upper 
part of the orbit, close to the bone ; and having passed 
through the supra-orbitary notch, is distributed to the 
forehead. 

(2.) The Nasal Nerve, or inner branch, runs towards 
the nose, and is distributed to the inner side of the orbit, 
and to the nose. 

(3.) The Temporal or Lachrymal Branch, supplies 
the lachrymal gland, and the parts at the outer side of 
the orbit. 

The Lenticular Ganglion is a small ganglion, situ- 
ated within the orbit, formed by short branches of the 
ophthalmic nerve, and by a twig of the third pair. It 
sends off delicate nerves, which run along the sides of 
the optic nerve, and pierce the coats of the eye. 

5. The second branch of the Fifth Pair, called the Su- 
perior Maxillary Nerve, sends off a branch through 
the bony canal in the bottom of the orbit. This is the 
Infra-orbitary Nerve. It accompanies an artery of 
the same name, and emerges on the face by the Infra- 
orbitary Foramen. 

6. The trunk of the Sixth Pair of nerves passes through 
the sphenoidal fissure to the external rectus muscle. 

These delicate nerves are surrounded with fat, and de- 
mand great care in their dissection. 



FEMALE MAMMAE. 97 



CHAPTER VIII. 
DISSECTION OF THE THORAX. 

OF THE MUSCLES WHICH LIE UPON THE OUTSIDE OF THE 
THOKAX. THE AXILLiE. 

To expose these muscles, carry an incision from the top 
of the sternum along the median line to the ensiform 
cartilage, from thence obliquely upwards through the 
axillae, and a few inches down the inner side of the arm. 
From the commencement of the first another along the 
clavicle to the acromion process. 

Notice the axillae, a conical cavity, having a muscular 
fold in front and behind. The former made by the 
Pectoralis Major muscle, the latter by the Latissimus 
Dorsi muscle. 

In removing the integuments from the forepart of the 
thorax, the pectoralis major and interior edge of the del- 
toid muscle should be dissected in the course of their 
fibres ; and to do this, it will be necessary to remember 
that the fibres run obliquely from the sternum and cla- 
vicle to the upper part of the os humeri. 

Of the Female Mammae. — Two glandular bodies placed 
upon the great pectoral muscles, having only the fascia 
interposed, upon which they readily move. In the centre 
is placed the Nipple, about which are many sebaceous 
follicles. Ten or fifteen ducts (Tubuli Lactiferi), com- 
mence at its extremity, and passing inwards divide and 
subdivide, which ultimately end in enlargements, from 
which pass off many others, to end finally in the ultimate 
lobules or vesicles of the organ. The lobules are sup- 
ported by prolongations from the cellular capsule of the 
gland, which pass through its substance. Much adipose 
structure is usually intermixed with the lobules. 



98 PKACTICAL ANATOMY. 

Its bloodvessels from the axillary, intercostal, and in- 
ternal mammary trunks. 

Three pair of muscles are described in the dissection 
of the thorax. 

1. The Pectokalis Ma joe — Arises, tendinous, from 
the anterior surface of the sternum, its whole length ; 
fleshy, from the cartilages of the fifth, sixth, and some- 
times the seventh ribs, and from two anterior thirds of 
the clavicle. The fleshy fibres run obliquely across the 
breast, and, converging, form a strong, flat tendon, which 
is 

Inserted into the ridge of the os humeri on the outside 
of the bicipital groove. 

Situation: The belly of this muscle is superficial. It 
is separated from the deltoid muscle by cellular mem- 
brane and fat, by the Cephalic Vein, and a small artery, 
named Humeeal Thoeacic. Its tendinous fibres, aris- 
ing from the sternum, are interlaced with those of the 
opposite, so as to "form a kind of fascia covering the bone; 
and the origins from the ribs are intermixed with the 
obliquus externus abdominis. The clavicular and thoracic 
portions of the muscle are separated by a line of cellular 
membrane which leads to the axillary vessels. 

The tendon is covered by the anterior edge of the del- 
toid ; it forms the anterior fold of the armpit, and ap- 
pears twisted, for the fibres which proceed from the tho- 
racic portion of the muscle, seem to pass behind those 
proceeding from the clavicle, and to be inserted into the 
os humeri somewhat higher up. 

Use: To move the arm forwards, and obliquely up- 
wards, towards the sternum. 

The pectoralis major should be lifted up from its origin. 
This will expose the next two muscles. 

2. The Pectoealis Minoe — Arises, by three tendinous 
and fleshy digitations from the upper edges of the third, 
fourth, and fifth ribs, near their cartilages; it forms a 
fleshy triangular belly, which becomes thicker and nar- 
rower as it ascends, and is 

Inserted, by a short flat tendon, into the anterior part of 
the coracoid process of the scapula. 



FEMALE MAMMJ. 



99 



Situation: The belly of this muscle is covered by the 
pectoralis major : the tendon passes under the anterior 
edge of the deltoid, and is connected at its insertion with 
the origins of the coraco-brachialis, and of the short head 

Fig. 29. 




Front View of the Pectoralis Major Muscle. 



of the biceps flexor cubiti, and also with the coraco- 
acromial ligament. 

Use: To draw the scapula forwards and downwards, 
and, when that bone is fixed, to elevate the ribs. Above 
its insertion notice some arteries presently to be described. 

3. The Subclavius — Arises, by a flat tendon, from 
the cartilage of the first rib, and forms a broad fleshy 
belly, which is 

Inserted into the inferior surface of the clavicle, begin- 
ning about one inch from the sternum, and continuing as 
the ligamentous connection of the clavicle to the coracoid 



process. 
Situation 



This muscle is situated between the clavicle 



100 



PRACTICAL ANATOMY. 



and sternum, concealed by the pectoralis major, and ante- 
rior part of the deltoides. 

Fig. 30. 




A Front View of the Subclavius and Pectoralis Minor Muscles. 
1. Subclavius. 2. Pectoralis Minor. 

Use : To draw the clavicle downwards and forwards, 
and perhaps to elevate the first rib. 

Having lifted np the pectoralis minor from its origin, 
the situation of the subclavian vessels which pass under 
the clavicle, and over the first rib, may be seen. 

Dissection of the Axilla. 

The axilla is formed by two muscular folds, which 
bound a middle cavity. The anterior fold is formed by 
the pectoralis major passing from the thorax to the arm, 
the posterior by the latissimus dorsi coming from the 
back. 

In the intermediate cavity there is a quantity of cellu- 
lar membrane and absorbent glands and fat, covering and 
connecting the great vessels and nerves ; and this is not 



DISSECTION OF THE AXILLA. 101 

exactly similar to the fat in other parts of the body ; it is 
more granulated, watery, and of a reddish color ; it sur- 
rounds the great vessels and nerves, rendering the dissec- 
tion both tedious and difficult. The lymphatic glands here 
are continuous under the clavicle with those of the neck. 

The Axillaey Vein will be found lying anterior to 
the artery, that is, nearer the integuments. The axillary 
vein receives branches corresponding to the ramifications 
of the artery. Passing under the clavicle, it becomes the 
subclavian vein, and runs over the first rib, and before 
the anterior scalenus muscle into the thorax. 

Deeper seated, and immediately behind the axillary 
vein, lies the Axillary Artery. It is seen coming 
from under the clavicle ; from under the arch formed by 
the pectoralis minor, it comes over the middle of the first 
rib, and between the anterior and middle scaleni muscles. 
In the axilla it is surrounded by the meshes of the axil- 
lary nerves, and runs under the tendon of pectoralis mi- 
nor along the inferior edge of the coraco-brachialis muscle ; 
when it has passed to the tendon of the latissimus dorsi 
muscle, it assumes the name of the Brachial Artery. 

The branches of the axillary artery are, 

1. A. Mammaria Externa, called also A. Thoracic^ 
Extemae. — The external mammary artery consists of four 
or five branches which run downwards and forwards ob- 
liquely over the chest. These branches sometimes come 
off separately from the axillary artery, at other times by 
one or two common trunks, which subdivide. They 
supply the pectoral muscles and mamma. Some of their 
branches pass to the muscles of the shoulder, to the side 
of the chest, and to the muscles on the inside of the sca- 
pula. They are as follows : — 

a. Thoracico Acromialis— going towards the fissure 
between the deltoid and pectoralis major. 

b. Thoracico Superior — to the pectoralis major. 

c. Thoracico Longa — along the border of the pecto- 
ralis minor and side of the chest. 

d. Thoracico Axillaris — to the glands and cellular 
tissue of the armpit. 

2. A. Subscapulars arises from the under and back 

9* 



102 PKACTICAL ANATOMY. 

part of the axillary artery, attaches itself to the inferior 
costa of the scapula, where* it splits into two great 
branches: 1. The Dorsalis Scapula, a large branch, which 
passes to the outer surface of the scapula below the spine, 
and has its principal ramifications close upon the bone. 
2. The other branch (which is larger) passes to the inner 
surface of the scapula, supplies the subscapularis, and 
sends branches downwards to the muscles of the back 
and loins. (See Fig. 30.) 

3. Arteria Circumflexa Humeri Posterior arises 
from the lower and forepart of the axillary artery, and 
runs backwards close to the bone, surrounds its neck, 
and is lost on the inner surface of the deltoid ; it gives 
also twigs to the joint and neighboring muscles. It is 
accompanied by the Circumflex Nerve. 

4. A. Circumflexa Anterior is a much smaller 
artery, often a branch of the circumflexa posterior; it 
encircles the neck of the bone on its forepart, and is lost 
on the inner surface of the deltoides, where it inosculates 
with the posterior circumflex artery. 

The Great Brachial Nerves accompany the subcla- 
vian artery over the first rib. In the axilla they are 
united by numerous cross branches, forming the Axillary 
or Brachial Plexus, which is continued from the clavicle 
as low as the edge of the tendon of the latissimus dorsi, 
and which surrounds the axillary artery with its meshes. 

From the axillary plexus seven nerves pass off. 

1. Nervqs Supra-scapularis. — This nerve comes off 
from the upper edge of the plexus ; it crosses the axilla 
at the highest part, runs towards the superior costa of the 
scapula, accompanies the external scapular artery through 
the semilunar notch, and supplies the muscles on the pos- 
terior surface of the scapula. 

2. N. Circumflexus lies deep; it passes from the back 
part of the plexus, goes backwards round the neck of the 
bone, accompanying the posterior circumflex artery, and 
is distributed to the deltoid and the muscles on the out- 
side of the arm. Small nerves also pass from the axillary 
plexus to the subscapular muscle (subscapular), the teres 
major, latissimus dorsi, and pectoral muscles. 



OF THE SHOULDER AND ARM. 103 

3. The External Cutaneous Nerve, or Nervus-Musculo- 
cutaneus. 

4. The Median Nerve. 

5. The Ulnar Nerve. 

6. The Musculo Spiral Nerve. 

7. The Internal Cutaneous Nerve. 

8. The Lesser Internal Cutaneous, or Nerve of "Wris- 
berg, formed by a filament from the second intercosto 
humeral, and another from the axillary plexus. 

At this exposure of parts a nerve may be observed 
descending close along the thorax upon the serratus mag- 
nus muscle. This is the Long Thoracic or External 
Eespiratory of Bell, and comes from the fourth and 
fifth cervical nerves. Two others come through the in- 
tercostal spaces, the Intercosto Humeral. They come 
from the intercostal nerves, and mingle with the axillary 
nerves. 

Six of these nerves will be described in the dissection 
of the arm and forearm. 



CHAPTEE IX. 
DISSECTION OF THE SUPERIOR EXTREMITY. 

OF THE SHOULDER AND ARM. 

An incision carried down the middle of the arm and 
integuments reflected, will expose the parts properly 
for dissection. The arm is invested with a superficial 
fascia, mingled with fat, in and beneath which are situated 
important veins. Beneath the superficial fascia is the 
Deep Fascia, consisting of fibres running circularly and 
longitudinally. This fascia is very thin over the deltoid. 
Strong at the internal condyle, and on the back of the 
forearm, sending processes in between the muscles and 
furnishing to them a surface of origin. 



104 



PRACTICAL ANATOMY. 



In removing the integuments, we meet with several 
cutaneous veins and nerves. 

The cutaneous veins 1 of the upper extremity are the 
following : — 

1. The Basilic Yein is seen arising from a small vein 
on the outside of the little finger, named Salvatella. It 
then runs along the inside of the forearm near the ulna, 

Fig. 31. 
Superficial Veins of the Superior Extremity. 



a. Commencement of the Cephalic Vein. 

b. Main Trunk of Cephalic Vein. 

c. Anterior Branch of Basilic Vein. 

d. Posterior Branch of Basilic Vein. 

e. Basilic Vein. 

f. Median Vein. 

g. Median Basilic Vein. 
h. Median Cephalic Vein. 
i. Biceps Muscle. 



1 The veins are described from their origin in the forearm for the 
sake of perspicuity. 



OF THE SHOULDER AND ARM. 105 

receiving the internal and external ulnar veins from the 
anterior and posterior surface of the fascia. It passes 
over the fold of the arm near the inner condyle of the 
humerus. It ascends along the arm, becoming more 
deeply seated, and included in the sheath which invests 
the brachial artery. As it approaches the neck of the 
humerus, it sinks deep betwixt the folds of the armpit, 
and terminates in the axillary vein, which may be con- 
sidered as a continuation of the basilic vein. It commu- 
nicates with the deeper-seated veins, and receives numerous 
branches from the muscles. 

2. The Cephalic Vein begins on the back of the 
hand, between the thumb and metacarpal bone of the fore- 
finger, by a small vein, named Cephalica Pollicis. It 
runs along the radius between the muscles and integu- 
ments, receiving the internal and external radial veins. 
It passes over the bend of the arm near the external 
condyle, and ascends along the outside of the arm near 
the outer edge of the biceps flexor cubiti. It then runs 
betwixt the edge of the deltoid and pectoral muscles, dips 
down under the clavicle, and enters the subclavian vein. 
In all this course the cephalic vein receives branches. 

3. The Median Yein. — Several veins are seen running 
along the middle of the anterior part of the forearm. The 
trunk formed by these veins is called the Median a Major. It 
ascends on the flat part of the forearm, betwixt the basilic 
and cephalic veins, and bifurcates at the fold of the arm 
into two branches : 1. The Mediana Basilica, passing off 
obliquely to join the basilic vein; 2. The Mediana 
Cephalica, which joins the cephalic. 

The cutaneous nerves of the arm are seen ramifying 
above the muscles ; they consist of, 

1. The Internal Cutaneous Nerve, a branch of the 
axillary plexus. It is seen accompanying the basilic vein, 
and twisting its fibres over it. It descends along the in- 
side of the arm, crosses over the forepart of the elbow- 
joint, and, in the dissection of the forearm, will be seen 
dividing itself into twigs, which ramify between the 
fascia and integuments, and are distributed to the inside 
of the forearm and wrist. 



106 PEACTICAL ANATOMY. 

2. The upper part of the arm receives cutaneous nerves 
from the branches of the dorsal nerves, which come out 
of the thorax between the ribs. 

3. The shoulder and back part of the scapula receive 
twigs from the cervical nerves. 

4. The external cutaneous, ulnar, and spiral nerves, 
also send twigs to the integuments of the arm and fore- 
arm. 

MUSCLES SITUATED ON THE SHOULDER AND ARM. 

These are ten in number. 

1. The Deltoides — Arises, tendinous and fleshy, from 
the posterior third of the clavicle, from the whole edge 
of the acromion, and from the lower margin of the whole 
spine of the scapula. From these several origins the 
fibres run in different directions, and converge to be 

Inserted, tendinous, into a triangular rough surface on 
the outer side of the os humeri, near its middle. 

Situation: This muscle is entirely superficial, except 
where the thin fibres of the platysma myoides arise from 
its anterior surface. It arises from the same extent of 
bone as the trapezius is inserted into. It is a coarse mus- 
cle, consisting of large fasciculi of fibres. It conceals the 
insertion of the pectoralis major, and the origins of the 
biceps flexor cubiti and coraco-brachialis, and covers the 
whole of the forepart and outside of the shoulder-joint. 
Its external surface is quite fleshy ; but, on cutting it 
across, its internal surface is found tendinous ; and where 
it slides over the great tuberosity of the humerus there 
is a large bursa. 

From the insertion of the deltoid to the outer condyle 
of the os humeri is extended an Intermuscular Ligament, 
which separates the muscles on the anterior part of the 
arm from those on the posterior part, and gives attach- 
ment to the fibres of both. It is named the External 
Intermuscular Ligament. It is only the deep fascia. 

Use: To draw the arm directly upwards, and to move 
it a little forwards and backwards, according to the dif- 
ferent directions of its fibres. Kefiect it from the scapula 



MUSCLES ON THE SHOULDER AND ARM. 107 

and clavicle, that you may expose more completely the 
muscles on the dorsum of the former bone. 

Fig. 32. 

A View of the Deltoid Muscle. 



1. Body of the Muscle. 

2. Its Insertion into the Clavicle. 

3. Its Insertion into the Spine of the 

Scapula. 

4. Its Insertion into the Humerus. 




The following two muscles, which fill up the posterior 
surface of the scapula, are covered by a fascia, which ad- 
heres to the spine and edges of that bone. On dissecting 
off this fascia, the fleshy fibres of the muscles will be 
found arising from its inner surface. 

2. The Supra Spinatus — Arises, fleshy, from all that 
part of the base of the scapula that is above its spine, 
from the superior costa as far forwards as the semilunar 
nitch, from the spine itself, and from the concave surface 
betwixt it and the superior costa. The fleshy fibres ter- 
minate in a tendon which passes under the acromion, 
slides over the neck of the scapula (to which it is con- 
nected by loose cellular membrane), adheres to the cap- 
sular ligament of the shoulder -joint, and is 

Inserted into the anterior and superior part of the great 
tuberosity near the head of the os humeri. 

Situation: This muscle fills up the fossa or cavity above 



108 



PRACTICAL ANATOMY. 



the spine of the scapula, and is entirely concealed by the 
fibres of the trapezius. 

Use : To raise the arm. 

The supra-scapular artery and nerve pass through this 
fossa. 

3. The Infra-Spin atus — Arises, principally fleshy, 
from the lower part of the spine of the scapula as far 
back as the triangular flat surface ; from the base of the 
bone below the spine to near the inferior angle; from the 
posterior ridge of the inferior costa; and from all the 
dorsum of the bone below the spine. The fibres ascend 
and descend towards a middle tendon, which runs for- 
wards over the neck of the bone, and adheres to the cap- 
sular ligament. 

Inserted, by a strong short tendon, into the middle part 
of the great tuberosity of the os humeri. 

Situation : This muscle is in part concealed by the del- 
toid, and the trapezius passes over its upper and back 
part ; but a considerable portion of the belly of this mus- 

Fig. 33. 




Muscles of the Scapula. 



1. Supra-spinatus. 

2. Infra-spinatus. 



3. Teres Minor. 

4. Teres Mai or. 



cle is seen betwixt these two muscles. It is inserted 
below the tendon of the supra-spinatus. 



THE SUBSCAPULARS. 109 

Use: To roll the humerus outwards, to assist in raising 
the arm, and in moving it outwards when raised. 

4. The Teres Minor — Arises, fleshy, from the narrow 
depression between the two ridges in the inferior costa of 
the scapula, extending from the neck of the bone to within 
an inch or two of the inferior angle. It passes forwards 
along the inferior edge of the infraspinatus, adheres to 
the capsular ligament of the shoulder-joint, and is 

Inserted, tendinous and fleshy, into the lower and back 
part of the great tuberosity of the os humeri. 

Situation: It is inserted below the tendon of the infra- 
spinatus. Its origin lies between the infra-spinatus and 
teres major, and partly concealed by them. Its insertion 
is concealed by the deltoid. The fascia which covers the 
infra-spinatus envelops also the teres minor ; and the two 
muscles are in some subjects so closely united as to be 
with difficulty separated. 

Use: To draw the humerus downwards and backwards, 
and to roll it outwards. 

5. The Teres Major — Arises from an oblong, rough, 
flattened surface, at the inferior angle of the scapula. It 
forms a thick belly, which passes forwards and upwards 
towards the inside of the arm. 

Inserted, by a broad thin tendon, into the ridge of the 
os humeri, at the inner side of the bicipital groove. 

Situation: Its belly passes before the long head of the 
triceps extensor cubiti. Its tendon is inserted along with 
the tendon of the latissimus dorsi. Observe the relative 
situation of these tendons; they both pass under the 
coraco-brachialis and short head of the biceps flexor, to 
reach the place of their insertion. They appear at first 
inseparably united, but on dividing them with some care 
we find an intermediate cavity lubricated with synovia. 

Use: To roll the humerus inwards, and to draw it 
backwards and downwards. 

6. The Subscapularis — Arises, fleshy, from all the 
base of the scapula internally, from the superior and in- 
ferior costas, and from the whole internal surface of the 
bone. It consists of tendinous and fleshy bundles, which 
converge, slide over the inner surface of the neck of the 

10 



110 PRACTICAL ANATOMY. 

scapula, pass in the hollow under the root of the coracoid 
process, aud adhere to the inner part of the capsular liga- 
ment of the shoulder-joint. 

Inserted, by a strong tendon, into the lesser tuberosity 
near the head of the os humeri. 

Fig. 34. 



Muscles of the Scapula. 

1. Subscapularis. 3. Part of Triceps. 

2. Teres Major. 4. Deltoid Muscle. 

Situation: The whole of this muscle is concealed by 
the scapula and muscles of the shoulder. It lies betwixt 
that bone and the serratus mag n us. 

Use : To roll the os humeri inwards, and to draw it to 
the side of the body. 

7. The Biceps Flexor Cubiti — Arises by two heads. 
The first and outermost, called the Long Head, arises, by 
a strong tendon, from a smooth surface in the upper edge 
of the glenoid cavity of the scapula. It passes over the 
head of the os humeri, within the capsular ligament of 
the shoulder-joint, and enters the bicipital groove. It 
forms a strong fleshy belly. The second and innermost, 
called the Short Head, arises, tendinous, from the lower 
part of the coracoid process of the scapula, in common 
with the coraco-brachialis, and sends off a fleshy belly. 

These two fleshy bellies form a thick mass, and, below 
the middle of the arm, become inseparably united. They 



BICEPS FLEXOR CUBITI. 



Ill 



send off a strong tendon, which passes into the forepart 
of the elbow-joint. 

Inserted into the posterior rough part of the tubercle 
of the radius. A bursa mucosa is placed between the 
tendon and front of the tubercle. 

Situation: The tendon of the long head cannot be seen 
till the capsular ligament of the shoulder is opened. The 
two origins are concealed by the deltoides and pectoralis 
major; and, at the bend of the elbow, its tendon sends off 
from its inside an aponeurosis (Bicipital), which assists 
in forming the fascia of the forearm, and covers the 
brachial artery, and median nerve. 



Fig. 35. 

Muscles of the Anterior Brachial Region, the Anterior Half of the 
Deltoid being cut away. 



1. Subscapularis Muscle. 

2. Biceps. 

3, 6. Teres Major. 

4, 4. Brachialis Anticus. 

5. Tendon of the Pectoralis Major. 

7. Internal Head of the Triceps. 

8. Tendinous Expansion of the Bi- 
ceps. 

Extremity of the Pectoralis 

Minor. 
Coraco-Brachialis. 

11. Long Head of the Biceps. 

12. Short Head of the Biceps. 

13. Coracoid Process of the Scapula. 



9. 



10. 




Use : To turn the hand supine, to bend the forearm on 
the arm, and the arm on the shoulder. 



112 PRACTICAL ANATOMY. 

8. The Coraco-Brachialis — Arises, tendinous and 
fleshy, from the middle part of the apex of the coracoid 
process of the scapula. Its fibres, as it descends, also 
arise from the edge of the short tendon of the biceps 
flexor cubiti. It forms a flat fleshy belly which is always 
perforated by the nerve, named Musculo-Cutaneus Ex- 
ternus ; 

Inserted, tendinous and fleshy, about the middle of the 
internal part of the os humeri, into a rough ridge. 

Situation: This muscle is much connected with the 
short head of the biceps flexor cubiti. In the arm it lies 
behind, and on the inside of the biceps, and is concealed 
partly by the pectoralis major and deltoides. It is insert- 
ed immediately below the tendons of the latissimus dorsi 
and teres major, and before the brachialis externus. The 
Axillary Artery is on its inner edge and the median 
nerve. 

The internal intermuscular ligament (Deep Fascia of 
the Arm) is seen extending from the lower part of this 
muscle along a ridge to the internal condyle, and separat- 
ing the brachialis internus from the brachialis externus, 
or third head of the triceps extensor cubiti. 

Use : To move the arm upwards and forwards. 

9. The Brachialis Internus — Arises from the middle 
of the os humeri, by two fleshy slips, which pass on 
each side of the insertion of the deltoid muscle ; fleshy 
from all the forepart of the bone below, nearly as far as 
the condyles. The fibres converge, pass over the elbow- 
joint, and adhere to the capsular ligament. 

Inserted, by a strong short tendon, into the rough sur- 
face immediately below the coronoid process of the ulna. 

Situation: The belly is almost entirely concealed by 
the biceps flexor cubiti, excepting a small portion which 
projects beyond the outer edge of that muscle. The 
tendon dips down betwixt the supinator radii longus and 
pronator teres, crosses under the tendon of the biceps 
flexor, and is inserted on the inside of that tendon. 

Use: To bend the forearm. 

10. The Triceps Extensor Cubiti is the great muscle 



TRICEPS EXTENSOR CUBITI. 118 

which covers all the back part of the arm. It arises by 
three heads. The first, or long head, arises, by a broad 
tendon, from the inferior costa of the scapula near its 
cervix, and forms a large belly, which covers the back 
part of the os humeri. The second, or short head, arises, 
on the outer and back part of the os humeri, by an acute 
tendinous and fleshy beginning, from a ridge which runs 
from the back part of the great tuberosity towards the 
outer condyle. They also arise from the surface of bone 
behind the ridge, and from the intermuscular ligament 
which separates them from the muscles on the forepart of 
the arm. The third head, called Brachialis Externus, 
arises, by an acute beginning, from the inside of the os 
humeri above its middle, and from a ridge extending to 
the inner condyle, from the surface behind this ridge, and 
from the internal intermuscular ligament. 

The three heads unite above the middle of the os 
humeri, and invest the whole back part of the bone. 
They form a thick strong tendon, which is 

Inserted into the rough back part of the process of the 
ulna, called Olecranon, and partly into the condyles of 
the os humeri, adhering firmly to the capsular ligament. 

Between the first and third head passes the muscnlo- 
spiral nerve. The Ulnar Nerve rests upon the front 
part of the triceps muscle, accompanied by the Inferior 
Profunda artery from the brachial. The Superior Pro- 
funda Artery accompanies the musculo-spiral nerve. 

Situation : The long head, where it arises from the 
scapula, is concealed by the deltoid ; it arises betwixt the 
teres minor and teres major. The short head arises im- 
mediately below the insertion of the teres minor. The 
tendon of the triceps sends off a thin fascia, which covers 
the triangular surface of the ulna, on which we commonly 
lean. Numerous fibres are also sent off, to assist in form- 
ing the fascia of the forearm. 

Use: To extend the forearm. The long head will also 
assist in drawing the arm backwards. 



10* 



114 PRACTICAL ANATOMY. 



DISSECTION OF THE FASCIA AND MUSCLES SITUATED ON 
THE CUBIT OR FOREARM. 

On removing the integuments of the forearm, we find 
a strong fascia investing all the muscles. It is attached 
to the condyles, and it adheres firmly to the olecranon of 
the ulna. It receives, on the posterior part, a great addi- 
tion of fibres from the tendon of the triceps extensor; 
and on the forepart of the arm, it appears to be a continua- 
tion of the aponeurosis which is sent off from the biceps 
flexor cubiti. 

Above the fascia we meet with several cutaneous veins 
and nerves. The veins have been already described ; the 
nerves are twigs of the branches of the brachial plexus, 
principally internal and external cutaneous. 

The relative situation of the vessels at the bend of the 
arm should be well attended to. The cutaneous veins 
situated here vary much in size. The vena basilica is 
seen running over the forepart of the bend of the arm 
near the inner condyle, the vena cephalica situated near 
the outer condyle; and each of these veins receives a 
branch passing obliquely from the vena mediana. These 
vessels lie above the fascia, while the brachial artery lies 
just beneath the fascia, in a hollow resembling that of 
the axilla. It descends over the joint near the inner con- 
dyle, on the inside of the tendon of the biceps flexor cu- 
biti, and under the aponeurosis sent off from that muscle 
to the common fascia of the forearm. It lies embedded 
in cellular substance, betwixt the pronator teres and flexor 
muscles of the wrist and fingers on one side, and the su- 
pinator longus and extensor muscles on the other. In 
this hollow it divides into the radial ulnar and interosseal 
arteries. The artery is accompanied by two veins, and 
on its inner side runs the radial nerve. 



ARISING FROM THE INNER CONDYLE OF THE OS HUMERI. 

These are eight in number, and may be divided into 
two classes, the superficial and the deep-seated. 



FLEXOR CARPI RADIALTS. 115 

First, the superficial. 

All the muscles passing from the inner condyle may- 
be said to arise by one common tendinous head from the 
condyle, and this head may be said to divide into the 
different muscles; but they will be here described as 
arising distinct from the condyle. It must, however, be 
recollected that their origins are intimately connected by 
intermuscular fascia, and that they cannot be separated 
without dividing some of their fibres. 

1. The Pronator Radii Teres — Arises, tendinous and 
fleshy, from the anterior surface of the inner condyle of 
the os humeri, and from the coronoid process of the ulna. 
It also arises from the fascia of the forearm. The fibres 
pass outwards, run by the side of the tubercle of the ra- 
dius, and pass over the outer edge of that bone, to be 

Inserted, tendinous and fleshy, into a rough surface on 
the back part of the radius about its middle. 

Situation: Of the muscles which pass from the internal 
condyle, the pronator teres is situated nearest the outer 
edge of the arm. Its tendon, to arrive at its place of 
insertion, passes under the belly of the supinator longus. 

Use: To roll the radius, together with the hand, in- 
wards. 

2. The Flexor Carpi Badialis — Arises, by a narrow 
tendinous beginning, from the lower and forepart of the 
internal. condyle of the os humeri; fleshy from the fascia 
and intermuscular ligaments, and from the upper end of 
the ulna. It forms a thick belly, which runs down the 
forearm, and terminates in a flat tendon. This tendon 
passes under the annular ligament 1 of the wrist, runs 
through a groove in the os trapezium, and is 

1 The annular ligament of the wrist consists of two parts : 1. The 
ligamentum carpi transversale externum passes from the styloid pro- 
cess of the ulna and os pisiforme, transversely, over the back of the 
wrist, and spreads out broad, to be affixed to the styloid process of the 
radius. Under it pass the tendons of the extensor muscles. 2. The 
ligamentum carpi transversale internum is a strong ligament, which 
passes across the forepart of the wrist. It arises from the os pisiforme 
and os unciforme on the inner edge of the wrist, and is attached to 
the os scaphoides and os trapezius on the outer edge. Under it pass 
the tendons of the flexor muscles. 



116 



PRACTICAL ANATOMY. 



Inserted into the forepart of the base of the metacarpal 
bone of the fore-finger. 

Situation: This muscle is situated immediately under 
the fascia, excepting its upper extremity, over which the 
pronator teres crosses. Its insertion cannot be seen till 
the palm of the hand is dissected, where it will be found 
concealed by the muscles of the ball of the thumb. 

Use: To bend the hand and to assist in its pronation. 

Fig. 36. 
The Muscles of the Front of the Forearm. 




1. Lower part of the Biceps. 

2. Part of the Brachialis Interims. 

3. Edge of the Triceps. 

4. Pronator Radii Teres. 

5. Flexor Carpi Radialis. 

6. Palmaris Longns. 

7. One of the Divisions of the Flexor Sublimis 

Digitorum. 

8. Flexor Carpi Ulnaris. 

9. Palmar Fascia. 

10. Palmar Brevis Muscle. 

11. Abductor Pollicis Manus. 

12. Portion of the Flexor Brevis Pollicis Manus. 

13. Supinator Radii Longus. 

14. Extensor Ossis Metacarpi Pollicis curving 

around the lower Border of the Forearm. 



3. The Palmaris Longus — Arises, by a slender ten- 
don, from the forepart of the inner condyle of the os 
humeri, and fleshy from the intermuscular ligament ; it 



FLEXOR SUBLIMIS PERFORATES. 117 

forms a short fleshy belly, which soon sends off a long 
slender tendon. This tendon descends along the forearm, 
and is 

Inserted, near the root of the thumb, into the ligamen- 
tum carpi transversale internum, and into a tendinous 
membrane that covers the palm of the hand named Pal- 
mar Fascia, or Aponeurosis Palmaris. 

Situation: It arises betwixt the flexor carpi radialis 
and flexor ulnaris. This muscle is sometimes wanting. 

Use: To bend the hand, and stretch the palmar apo- 
neurosis. 

4. The Flexor Carpi Ulnaris — Arises, tendinous, 
from the inferior part of the internal condyle of the os 
humeri ; tendinous and fleshy, from the inner side of the 
olecranon, and by a tendinous expansion from the poste- 
rior ridge of the ulna, to near the lower end of the bone. 
It also arises from the intermuscular fascia and fascia of 
the forearm. The fibres pass obliquely forwards into a 
tendon which runs over the forepart of the ulna, and is 

Inserted into the os pisiforme, and sometimes sends its 
fibres over a small ligament which goes to the base of the 
metacarpal bone of the little finger. 

Situation: This muscle runs along the inner edge of 
the forearm, between the flexor sublimis on the forepart, 
and the extensor-carpi-ulnaris on the back part of the 
ulna. 
* Use : to bend the hand. 

5. The Flexor Sublimis Perforatus — Arises, tendi- 
nous and fleshy, from the under part of the internal con- 
dyle of the os humeri ; tendinous, from the lower part of 
the coronoid process of the ulna; fleshy, from the tuber- 
cle of the radius, from the middle of the forepart of that 
bone, and from the middle third of its outer edge. 
These origins form a strong fleshy mass, which sends off 
four tendons. These tendons are connected by cellular 
membrane, and pass together under the annular ligament 
of the wrist ; after which they separate, become thinner 
and flatter, pass along the metacarpal bone and first pha- 
lanx of each of the fingers, and are 

Inserted into the anterior and upper part of the second 



118 PRACTICAL ANATOMY. 

phalanx, each tendon being, near the extremity of the 
first phalanx, divided for the passage of a tendon of the 
flexor profundus. 

Situation: To expose the origin of this muscle, the 
bellies of the pronator teres, flexor carpi radialis, and 
palmaris longus, must be detached from the condyle. It 
descends along the forearm under these muscles, but a 
part of it is seen projecting towards the inner edge of the 
arm, betwixt the tendons of the palmaris longus and 
flexor carpi ulnaris. It arises from the radius below the 
insertion of the biceps flexor cubiti. Its tendons will be 
seen in the dissection of the palm of the haud. 

Use: To bend the second joint or phalanx of the 
fingers. 

Notice the following bloodvessels and nerves, which 
will be discussed in detail, when the dissection of the arm 
has been finished. 

Brachial Artery at the bend of the arm, the median 
nerve on its inner side. The artery divides into Radial 
and Ulnar. 

The Radial crosses to the radial side of the arm, at the 
root of the thumb passes under its extensor tendons. Its 
branches are 

Recurrens Radialis, toward external condyle. 

Muscular, to the muscles. 

Superficialis Yol^:, to the ball of the thumb. 

Carpal. Anterior and Posterior. These are all 
that can be seen at the present stage of the dissection. 

Radial Nerve, to the outside of the artery. 

A. Ulnaris. — Its first part deep under several muscles 
which arise from the internal condyle, and not visible, 
emerges on the ulnar side of arm, and passes down the 
arm between the Flexor Carpi Ulnaris and Flexor 
Sublimis Digitorum, over the annular ligament into the 
hand, to form the arcus sublimis. The ulnar nerve is to 
its ulnar or inner border. Its branches are 

Recurrens Ulnaris — Passes back toward the inter- 
nal condyle. 

Interossea — Too deep to be seen yet. 



FLEXOR PROFUNDUS PERFORANS. 



119 



Dorsalis Manus — Leaves the ulnar at the lower part 
of the arm, and passes to the back of the wrist. 

Fig. 37. 
A View of the Arteries of the Forearm. 



17. 

18. 
19. 

20. 



The Lower Part of the Biceps Muscle. 

The Inner Condyle of the Humerus, 
with the Humeral Origin of the 
Pronator Radii Teres and Flexor 
Carpi Radialis Muscles cut across. 

The deep portion of the Pronator 
Teres Muscle. 

The Supinator Longus Muscle. 

The Flexor Longus Pollieis. 

The Pronator Quadratus. 

The Flexor Digitorum Profundus. 

The Flexor Carpi Ulnaris. 

The Anterior Annular Ligament. The 
figure is placed on the Tendon of 
the Palmaris Longus Muscle, di- 
vided close to its insertion. 

The Brachial Artery. 

The Great Anastomotic Artery. 

The Radial Artery. 

The Radial Recurrent Artery. 

The Superficialis Volse Artery. 

The Ulnar Artery. 

Its Superficial Palmar Arch giving 
Digital Branches to three fingers 
and a half. 

The Great Artery of the Thumb 
(Magna Pollieis). 

The Posterior Ulnar Recurrent. 

The Anterior Interosseous Artery. 

The Posterior Interosseous, as it is 
passing through the Interosseous 
ligament. 




By removing the belly of the flexor sublimis, we ex- 
pose the deep-seated muscles. 

6. The Flexor Profundus Perforans — Arisesfieshy, 
from the smooth concavity on the inside of the ulna, be- 
twixt the coronoid process and the olecranon ; from the 
smooth flat surface of the ulna, betwixt its posterior and 
internal angles ; from the under part of the coronoid pro- 
cess, and from the forepart of the ulna below that process. 



120 PRACTICAL ANATOMY. 

It also arises from the inner half of the interosseous liga- 
ment. This muscle forms a thick mass, which descends 
along the forepart of the ulna, adhering to that bone as 
low as one-third of its length from its inferior extremity, 
and terminates in sending off four tendons. These ten- 
dons pass together under the annular ligament of the 
wrist, run through the slits in the tendons of the flexor 
sublimis, and are 

Inserted into the fore and upper part of the third or 
last phalanx of all the fingers. 

Situation : This muscle is concealed by the flexor sub- 
limis and flexor carpi ulnaris. Its tendons will be seen 
in dissecting the hand. 

Use : To bend the last joint of the fingers. 

7. Flexor Longus Pollicis Manus — Arises, by an 
acute fleshy beginning, from the upper and forepart of 
the radius, immediately below its tubercle, fleshy from 
the outer edge and anterior surface of that bone as low as 
two inches above its inferior extremity, and from the 
outer part of the interosseous ligament. It has also 
generally a tendinous origin from the internal condyle of 
the os humeri. This origin forms a distinct fleshy slip, 
which is joined to the inner and upper part of the portion 
of the muscle arising from the radius. The fibres pass 
obliquely into a tendon on the anterior surface of the 
muscle. The tendon passes under the annular ligament 
of the wrist, runs between the two heads of the short 
flexor of the thumb, and between the two sesamoid bones, 
and is 

Inserted into the base of the extreme phalanx of the 
thumb. 

Situation : This muscle lies by the side of the flexor 
profundus ; the portion which arises from the inner con- 
dyle passes over the belly of the flexor profundus, and 
under the flexor sublimis. Its tendon will be seen in dis- 
secting the short muscles of the thumb. 

Use : To bend the last joint of the thumb. 

On separating the lower part of the two last described 
muscles, we expose a small square muscle, passing trans- 
versely just above the wrist. 



PKONATOR QUADRATUS. 



121 



8. The Pronator Quadratus — Arises, broad, tendi- 
nous, and fleshy, from the inner edge of the ulna, extend- 
ing from the lower extremity of the bone two inches up 
its edge. The fibres run transversely, adhere to the inter- 
osseous ligament, and are 

Fig. 38. 
A Fuont View of some of the Muscles of the Forearm. 



1. Pronator Radii Teres. 

2. Pronator Quadratus. 

3. Supinator Radii Brevis. 




Inserted into the lower and anterior part of the radius. 1 
Situation: This muscle lies close to the bones, covered 
by the flexor longus pollicis and flexor digitorum sub- 
limis. 

Use: To turn the radius, together with the hand, in- 
wards. 



1 This muscle, if carefully examined, will be seen to consist of two 
sets of fibres, having different directions — first pointed out, I believe, 
by Dr. J. Rhea Barton, of this city. 

11 



122 PRACTICAL ANATOMY. 



MUSCLES SITUATED ON THE OUTER AND BACK PART OF 
THE FOREARM, AND ARISING FROM THE OUTER CON- 
DYLE OF THE OS HUMERI. 

These muscles are eleven in number, and may be di- 
vided into two classes: 1. The Superficial; and 2. The 
deep-seated. 

The Superficial. 

The muscles which arise from the outer condyle are 
much more distinct in their origins than those which arise 
from the inner condyle. Several of them arise a con- 
siderable way up the os humeri ; but there is here also a 
common tendinous origin, from which the extensor carpi 
radialis brevior, extensor digitorum communis, and ex- 
tensor carpi radialis longior proceed, so that these muscles 
are intimately connected. 

1. Supinator Eadii Longus — Arises, tendinous and 
fleshy, from the external ridge of the os humeri which 
leads to the outer condyle. It begins to arise nearly as 
far up as the middle of the bone, and ceases to adhere 
about two inches above the condyle. It forms a thick 
fleshy belly, which passes over the side of the elbow- 
joint, becomes smaller, and terminates above the middle 
of the forearm in a flat tendon. The tendon becomes 
gradually rounder, and is 

Inserted into a rough surface on the outer side of the 
inferior extremity of the radius. 

Situation : This muscle is situated immediately under 
the integuments along the outer edge of the arm and fore- 
arm. Its origin lies betwixt the brachialis internus and 
short head of the triceps extensor cubiti. Its insertion 
is crossed by the extensors of the thumb. 

Use: To roll the radius outwards, and turn the palm of 
the hand upwards ; also to bend the forearm on the hu- 
merus. 

2. The Extensor Carpi Eadialis Longior — Arises, 
tendinous and fleshy, from the external ridge of the os 



EXTENSOR DIGITORUM COMMUNIS. 123 

humeri, beginning immediately below the origin of the 
supinator longus, and continuing to arise as far as the 
upper part of the outer condyle. It forms a thick short 
belly, which passes over the side of the elbow-joint, and 
terminates above the middle of the radius in a flat tendon. 
The tendon runs along the radius, and, becoming rounder, 
passes through a groove in the back part of the inferior 
extremity of that bone, to be 

Inserted into the posterior and upper part of the meta- 
carpal bone of the fore-finger. 

Situation: The belly lies under the supinator longus, 
but part of it projects behind that muscle. The tendon 
descends behind that of the supinator, and passes under 
the extensors of the thumb and annular ligament of the 
wrist, to arrive at the place of its insertion. 

Use: To extend the wrist and move the hand back- 
wards, and to assist in bending the forearm. 

3. The Extensor Carpi Radialis Brevior — Arises, 
tendinous, from the under and back part of the external 
lateral ligament of the elbow-joint. Its thick belly runs 
along the outside of the radius, and terminates in a ten- 
don, which passes through the same groove in the radius 
as the extensor radialis longior, and under the annular 
ligament. 

Inserted, by a round tendon, into the upper and back 
part of the metacarpal bone that supports the middle 
finger. 

Situation: This muscle lies partly under the extensor 
radialis longior; but it also projects behind it. It passes 
under the extensors of the thumb and the indicator. 

Use: To extend the hand. 

4. The Extensor Digitorum Communis — Arises, ten- 
dinous, from the under part of the external condyle of 
the os humeri ; fleshy, from the intermuscular fascia, and 
from the inner surface of the fascia. It descends along 
the back part of the forearm, and adheres to the ulna 
where it passes over it. The fleshy belly terminates in 
four flat tendons, which pass under the annular ligament 
in a depression on the back part of the radius, and are 



124 



PEACTICAL ANATOMY. 



Inserted into the posterior part of all the bones of the 
fingers by a tendinous expansion. 

Situation : It arises and descends betwixt the extensor 
radialis brevior and the extensor carpi ulnaris, and is 
situated immediately under the integuments. The tendons 
are connected on the back of the metacarpal bone by 
cross slips. The inner part of this muscle is sometimes 
described as a separate muscle, and is called Extensor 



Fig. 39. 
The Superficial Layer of Muscles on the Back and Forearm. 



The Lower Part of the Biceps, 

Part of the Brachialis Interims. 

The Insertion of the Triceps into the Ole- 
cranon. 

The Supinator Radii Longus. 

The Extensor Carpi Radialis Longior. 

The Extensor Carpi Radialis Brevior. 

The Tendinous Insertion of these two 
Muscles. 

The Extensor Communis Digitorum. 

The Extensor Minimi Digiti. 

The Extensor Carpi Ulnaris. 

The Anconeus. 

Part of the Flexor Carpi Ulnaris. 

The Extensor Minor Pollicis and the Ossis 

• Metacarpi Pollicis lying together. 

The Extensor Major Pollicis ; its tendon 
is seen crossing the tendons of the two 
radio-carpal extensors. 

The Posterior Annular Ligament. The 
tendons of the extensor communis are 
seen upon the back of the hand, and 
also their mode of distribution on the 
backs of the fingers. 



Proprius Minimi Digiti, vel Auricularis. It passes 
through a separate depression of the radius and a particu- 
lar ring of the annular ligament. 




EXTENSOR CARPI ULNARIS. 125 

Use : To extend all the joints of the fingers. 

The posterior surface of each finger is covered with a 
tendinous expansion, which is formed by the tendons of 
the common extensor, of the lumbricales, and interossei. 
This tendinous expansion terminates in the third or ex- 
treme phalanx. 

5. The Extensor Carpi Ulnaris — Arises, tendinous, 
from the upper part of the external condyle : fleshy, from 
the intermuscular fascia and inside of the fascia. It 
crosses towards the ulna, and arises, fleshy, from the back 
part of that bone. It terminates in a strong tendon, 
which passes through a groove in the back part of the 
lower end of the ulna, under the annular ligament, and 
is 

Inserted into the posterior and upper part of the meta- 
carpal bone of the little finger. 

Situation: This muscle is entirely superficial. It arises 
from the condyle betwixt the extensor digitorum commu- 
nis and anconeus. 

Use: To extend the wrist, and bring the hand back- 
wards; but chiefly to bend the hand laterally towards 
the ulna, as it will appear by pulling its tendon in the 
dissected subject. 

6. The Anconeus is a small triangular muscle, situated 
at the outer side of the olecranon, immediately under the 
integuments. 

It arises, tendinous, from the posterior and lower part 
of the external condyle of the os humeri; forms a thick 
triangular fleshy mass, adhering to the capsular ligament 
of the elbow-joint, and is 

Inserted into the concave surface on the outside of the 
olecranon, and into the posterior edge of the ulna. 

Situation : This muscle lies betwixt the upper part of 
the extensor carpi ulnaris and the olecranon. It is partly 
covered by the tendon of the triceps extensor cubiti, and 
is enveloped in a fascia sent off from that tendon. 

Use: To assist in extending the forearm. 
. By removing the superficial muscles, we expose 

11* 



126 PRACTICAL ANATOMY. 



The Deep-Seated. 

7. The Supinator Eadii Brevis — Arises, tendinous, 
from the lower part of the external condyle of the os 
humeri ; tendinous and fleshy, from the ridge running 
down from the coronoid process along the outer surface 
of the ulna. The fibres adhere firmly to the ligament 
that joins these two bones, pass outwards round the upper 
part of the radius, and are 

Inserted into the upper and outer edge of the tubercle 
of the radius, and into an oblique ridge extending from 
the tubercle downwards and outwards to the insertion of 
the pronator teres. 

Situation: This muscle nearly surrounds the upper and 
outer part of the radius. It is concealed at the outer 
edge of the arm by the supinator longus and extensores 
carpi radiales ; behind, by the extensor digitorum com- 
munis, extensor carpi ulnaris, and anconeus; before, by 
the brachialis internus, and by the tendon of the biceps 
flexor cubiti, close to which tendon this muscle is in- 
serted. 

Use : To roll the radius outwards, and bring the hand 
supine. 

On the back part of the forearm we meet with three 
muscles going to the thumb, and one to the fore-finger. 

8. The Extensor Ossis Metacarpi Pollicis — Arises, 
fleshy, from the middle and posterior part of the ulna, 
immediately below the termination of the anconeus, from 
the interosseous ligament, and from the posterior surface 
of the radius below the insertion of the supinator radii 
brevis. The fleshy fibres terminate in a tendon which 
passes through a groove in the outer edge of the lower 
extremity of the radius. 

Inserted, generally by two tendons, into the os trape- 
zium, and into the upper and back part of the metacarpal 
bone of the thumb. 

Use: To extend the metacarpal bone of the thumb 
outwardly. 

9. The Extensor Primi Internodii Pollicis Manus 
— Arises, fleshy, from the back part of the ulna below its 



INDICATOR. 127 

middle, from the interosseous ligament and radius. It 
runs along the lower edge of the extensor ossis meta- 
carpi, and forms a tendon, which passes through the same 
groove as the tendon of that muscle, and is 

Inserted into the posterior part of the first bone of the 
thumb. Part of the tendon is also continued into the 
base of the second or extreme phalanx. 

Use: To extend the first phalanx of the thumb ob- 
liquely outwards. 

10. The Extensor Secundi Internodii Pollicis 
Manus — Arises, tendinous and fleshy, from the posterior 
surface of the ulna above its middle, and from the inter- 
osseous ligament. Its belly partly covers the origins of 
the two other extensors of the thumb, and terminates in 
a tendon, which runs through a distinct groove in the 
back part of the radius, and is 

Inserted into the posterior and upper part of the second 
or extreme phalanx of the thumb. 

Use : to extend the last joint of the thumb obliquely 
backwards. 

Situation of the extensors of the thumb. — The origins 
of these muscles are concealed by the extensor digito- 
rum communis and extensor carpi ulnaris. The tendon 
of the extensor secundi internodii is at a considerable 
distance from the tendons of the two other extensors ; 
so that, in the intermediate space, we see the terminations 
of the tendons of the extensores carpi radiales. They 
invest the back part of the thumb with a fascia. 

11. The Indicator — Arises, by an acute fleshy begin- 
ning, from the middle of the back part of the ulna, and 
from the interosseous ligament. Its tendon passes through 
the same sheath of the annular ligament with the exten- 
sor digitorum communis, and is 

Inserted into the posterior part of the fore-finger with 
the tendon of the common extensor. 

Situation : It arises nearer to the inner edge of the arm 
than the extensor secundi internodii pollicis. It is con- 
cealed by the extensor digitorum communis and extensor 
carpi ulnaris. The tendon passes under that of the com- 
mon extensor. 



128 PRACTICAL ANATOMY. 

Use: To assist in extending the fore-finger. 

Posterior Interossea Artery, resting on the poste- 
rior part of the interosseous ligament, supplying muscles, 
and anastomosing with carpal arteries on the back of 
the wrist. 

dissection of the palm of the hand. 

The tendons which pass over the bones of the carpus 
into the palm of the hand are firmly bound down by the 
annular ligament of the wrist. They are invested and 
connected by cellular membrane, which forms sheaths, 
and secretes synovia to facilitate their motions. 

On removing the integuments from the palm of the 
hand we meet with a strong fascia. It arises from the 
tendon of the palmaris longus and from the annular liga- 
ment of the wrist, expands over all the palm of the hand, 
and is fixed to the roots of the fingers, splitting to trans- 
mit their tendons. These forks or splits are connected 
by transverse fibres. This is the Fascia or Aponeurosis 
Palmaris. It is triangular. Where it arises from the 
wrist it is narrow, and does not cover the bases of the 
metacarpal bones of the little and fore-finger. As it runs 
over the hand it becomes broader, and is fixed by a bifur- 
cated extremity in the lower end of each of the metacar- 
pal bones of the four fingers. The palmar fascia is strong 
and thick, and conceals and supports the muscles of the 
hand. Its deep surface is connected to the interosseous 
fascia by two membranous prolongations. It exerts great 
influence on deep-seated abscesses of this part. 

There is a small thin cutaneous muscle situated be- 
tween the wrist and the little finger. 

The Palmaris Brevis — Arises from the annular liga- 
ment of the wrist, and from the inner edge of the fascia 
palmaris. 

Inserted, by small scattered fibres, into the skin and fat 
which cover the short muscles of the little finger and 
inner edge of the hand. 

Use: To assist in contracting the palm of the hand. 

The Fascia Palmaris may now be removed. Under 



ABDUCTOR POLLICIS MANUS. 129 

it will be seen the arcus sublimis and the digital nerves 
from the ulnar and median presently to be described, and 
the four tendons of the flexor sublimis perforatus. They 
are seen coming from beneath the annular ligament of the 
wrist, and diverging as they pass towards their respeotive 
fingers. Each tendon splits at the extremity of the first 
phalanx for the passage of the tendon of the flexor pro- 
fundus perforatus, and inserted into the base of the second 
phalanx. 

Under the flexor sublimis are the four tendons of the 
flexor profundus perforans, which pass through the slits 
in the tendons of the former, and are inserted into the 
bases of the third phalanges of the fingers. 

The Lumbricales are four small muscles, which arise, 
tendinous and fleshy, from the outer side of the tendons 
of the flexor profundus perforans, soon after those ten- 
dons have passed the ligamentum carpi annulare. Each 
of these muscles has a small belly, which terminates in a 
tendon. The tendon runs along the outer edge of the 
finger, and is 

Inserted into the tendinous expansion which covers the 
back part of the phalanges of the fingers about the mid- 
dle of the first joint. 

Use: To bend the first phalanges of the fingers, the 
flexor profundus being previously in action, to afford 
them a fixed point. 

The short muscles of the thumb and fore-finger are five 
in number. 

1. The Abductor Pollicis Manus — Arises, by a broad 
tendinous and fleshy origin, from the anterior surface of 
the annular ligament of the wrist, and from the os navi- 
culare and os trapezium. 

Inserted, tendinous, into the outer side of the root of 
the first phalanx of the thumb, and into the tendinous 
membrane which covers the back part of all the pha- 
langes. 

Situation: This muscle is situated immediately under 
the integuments, and is the outermost portion of the mus- 
cular mass forming the ball of the thumb. 

Use: To draw the thumb from the fingers. 



130 



PKACTICAL ANATOMY. 



2. The Flexor Ossis Metacarpi Pollicis, or Oppo- 
nens Pollicis — Arises, broad and fleshy, from the annular 



Fig. 40. 




A Front View of the deep-seated Palmar Muscles. 



1. Pronator Quadratus. 

2. Opponens Pollicis. 

3. Its attachment to the Annular 

Ligament. 

4. Adductor Pollicis arising from 

the whole front of the second 
Metacarpal bone (Os Trape- 
zium and Os Magnum). 

5. Adductor Metacarpi Minimi 
Digiti. 

6. Its Origin from the Os Unci- 

forme. 



7. 



10. 
11. 
12. 
13. 
14. 



Os Pisiforme. 

9, 10, 11, 12, 13, 14. Interossei 

Muscles. 
Prior Indicis. 
Posterior Indicis. 
Prior Medii. 
Posterior Medii. 
Prior Annularis. 
Posterior Annularis. 
Interosseus Digiti Auricu- 

laris. 



ADDUCTOR POLLICIS MANUS. 131 

ligament of the wrist, and from the os naviculare and os 
trapezium. 

Inserted tendinous and fleshy, into the anterior and 
lower part of the metacarpal bone of the thumb. 

Situation : It lies under the abductor pollicis, and is 
almost entirely concealed ; but a few of its fibres are seen 
projecting beyond the edge of that muscle. 

Use: To bring the first bone of the thumb inwards. 

3. The Flexor Brevis Pollicis Manus arises by two 
distinct heads. 

(1.) The outer head arises from the inside of the annu- 
lar ligament ; from the anterior surface of the os trape- 
zium and os trapezoides, and from the root of the meta- 
carpal bone of the fore-finger. 

Inserted into the outer sesamoid bone, which is connected 
by a ligament to the root of the first phalanx of the 
thumb. 

(2.) The inner head arises from the upper part of the 
os magnum and os unciforme, and from the root of the 
metacarpal bone of the middle finger. 

Inserted into the inner sesamoid bone, which is connect- 
ed by a ligament to the root of the first phalanx of the 
thumb. 

Situation : This muscle is in great part concealed by 
the abductor pollicis. Its inner origin is under the first 
lumbricalis ; its upper part is seen projecting, and between 
its two portions we find the tendon of the flexor longus 
pollicis. 

Use: to bend the first joint of the thumb. 

4. The Adductor Pollicis Manus — Arises, fleshy, 
from almost the whole length of the metacarpal bone 
sustaining the middle finger. The fibres converge, and 
pass over the metacarpal bone of the fore-finger, to be 

Inserted, tendinous, into- the inner part of the root of 
the first phalanx of the thumb. 

Situation : The belly of this muscle is concealed, as it 
lies close to the bone under the tendons of the flexor pro- 
fundus and lumbricales. The tendon is seen where it is 
inserted into the thumb. 

Use : To pull the thumb towards the fingers. 



132 PRACTICAL ANATOMY. 

5. The Adductor Indicis Manus — Arises, tendinous 
and fleshy, from the os trapezium, and from the inner 
side of the metacarpal bone of the thumb. It forms a 
fleshy belly, runs over the side of the first joint of the 
fore-finger, and is 

Inserted, by a short tendon, into the outer side of the 
root of the phalanx of the fore-finger. 

Situation : This muscle is seen most distinctly on the 
back of the hand. It is there superficial, and is crossed 
by the tendon of the extensor secundi internodii pollicis. 
In the palm of the hand it is concealed by the muscles of 
the ball of the thumb. 

Use: To move the fore-finger towards the thumb, or 
the thumb towards the fore-finger. 

The insertion of the flexor carpi radialis is exposed by 
removing the muscles of the thumb. 

The short muscles of the little finger are three " in 
number. 

1. The Abductor Minimi Digiti Manus — Arises, 
fleshy, from the os pisiforme, and adjacent part of the 
annular ligament of the wrist. Its fibres extend along 
the metacarpal bone of the little finger. 

Inserted, tendinous, into the inner side of the first pha- 
lanx, and into the tendinous expansion which covers the 
back part of the little finger. 

Situation: The. belly of this muscle is superficial. It 
is only covered by the straggling fibres of the palmaris 
brevis. 

Use : To draw the little finger from the rest. 

2. The Flexor Parvus Minimi Digiti — Arises, fleshy, 
from the outer side of the os unciforme, and from the 
annular ligament of the wrist, where it is affixed to that 
bone. 

Inserted, by a roundish tendon, into the base of the first 
phalanx of the little finger. 

Situation: This muscle is also covered by the fibres of 
the palmaris brevis. It lies on the inner side of the ab- 
ductor minimi digiti, and its tendon is connected to the 
tendon of that muscle. 



INTEROSSEI INTERNI. 133 

Use: To bend the little finger, and bring it towards 
the other fingers. 

3. Adductor Metacarpi Minimi Digiti Manus — 
Arises, fleshy, from the os unciforme, and adjacent part of 
the annular ligament of the wrist. It forms a thick mass, 
which is 

Inserted, tendinous, into the forepart of the metacarpal 
bone of the little finger, nearly its whole length. 

Situation : It is concealed by the bellies of the abductor 
and flexor brevis minimi digiti. 

Use: To bend and bring the metacarpal bone of the 
little finger towards the rest. 

The Interossei are small muscles situated between the 
metacarpal bones, and extending from the bones of the 
carpus to the fingers. They are exposed by removing 
the other muscles of the thumb and fingers. 

The Interossei Interni are seen in the palm of the 
hand, and are four in number. They arise, tendinous 
and fleshy, from the base and sides of the metacarpal 
bones, and are inserted into the side of the first phalanx 
of the fingers, and into the tendinous expansion which 
covers the posterior surface of all the phalanges. The 
Arcus 'profundus runs across the metacarpal bones and 
these muscles. 

1. The First, named Prior Indicis, arises from the outer 
part of the metacarpal bone of the fore-finger, and is 
Inserted into the outer side of the first phalanx of that 
finger. Use: To draw the fore-finger towards the thumb. 

2. The Second, named Posterior Indicis, arises from 
the root and inner side of the metacarpal bone of the 
fore-finger ; and is inserted into the inner side of the first 
phalanx of the fore-finger. Use: To draw that finger 
outwards. 

3. The Third, named Prior Annularis, arises from the 
root and outer side of the metacarpal bone of the ring- 
finger ; and is inserted into the outer side of the first pha- 
lanx of the same finger. Use: To pull the ring-finger 
towards the thumb. 

4. The Fourth, named Interosseus Auricularis, arises 
from the root and outer side of the metacarpal bone of 

12 



134 PRACTICAL ANATOMY. 

the little finger ; and is inserted into the outer side of the 
first phalanx of the little finger. Use : To draw the little 
finger outwards. 

The internal interossei also assist in extending the 
fingers obliquely. 

The Interossei Externi, seu Bicipites, are three in num- 
ber. They are larger than the internal, and are situated 
betwixt the metacarpal bones on the back of the hand. 
Each of these muscles arise, by a double head, from two 
metacarpal bones, and is inserted into the side of one of 
the fingers, and into the tendinous expansion which covers 
the posterior part of the phalanges. 

1. The First, named Prior Medii, arises from the roots 
of the metacarpal bones of the fore and middle fingers ; 
and is inserted into the outer side of the middle finger. 

Use : To draw the middle finger towards the thumb. 

2. The Second, named Posterior Medii, arises from the 
roots of the metacarpal bones of the middle and ring- 
fingers, and is inserted into the inner side of the middle 
finger. Use : To draw the middle finger towards the ring- 
finger. 

3. The Third, named Posterior Annularis, arises from 
the roots of the metacarpal bones of the ring and little 
fingers ; and is inserted into the inner side of the ring- 
finger. Use : To draw the ring-finger inwards. The ex- 
ternal interossei also extend the fingers. 



OF THE VESSELS AND NERVES OP THE SUPERIOR 
EXTREMITY. 

Arteries. 

The subclavian and axillary arteries have been de- 
scribed. 

The Brachial Artery may be said to have its course 
along the inside of the arm. Having left the axilla, it 
runs along the inferior edge of the coraco-brachialis. 
Rather higher up than the middle of the os humeri, it 
crosses over the tendinous insertion of that muscle, being 
here situated between the belly of the biceps flexor cubiti, 



ARTERIES. 



135 



and the superior fibres of the brachialis externus. The 
artery then passes behind the inner edge of the biceps 
flexor cubiti, descending betwixt that muscle and the 
fibres of the brachialis internus. In dissecting this ves- 
sel, we find it invested by a fascia or sheath, formed by 
cellular membrane and some tendinous fibres. On dis- 
secting this fascia, we find, close to the margin of the 
coraco-brachialis and biceps flexor cubiti, the great median 
nerve; under it the brachial artery, and, more superfi- 
cially seated, the venae comites and the vena basilica. As 
the artery approaches the lower extremity of the os hu- 
meri, it inclines forwards toward the fold of the arm, and 
dives beneath the aponeurosis which arises from the in- 
side of the tendon of the biceps flexor cubiti. Its situa- 
tion at the fold of the arm has been described. 

Fig. 41. 
A View of the Axillary and Brachial Arteries. 



2,3. 

4,5, 



10. 
11. 
12. 
13. 
14. 
15. 
16. 
17. 
18. 



Axillary Artery, which ends 
at 2 in the Brachial. 

Brachial Artery. 
6, 7. External Thoracic Arte- 
ries. 

Subscapular Artery. 

Its Dorsal Branch. 

Posterior Circumflex. 

Anterior Circumflex. 

Profunda Superior. 

Profunda Inferior vel Minor. 

Anastomotic Artery. 

Subscapularis Muscle. 

Teres Major. 

Biceps Flexor Cubiti. 

Triceps. 




136 PRACTICAL ANATOMY. 

Branches of the Brachial Artery. 

1. A. Profunda Humeri Superior, or Muscularis Su- 
perior, is sent off from the inner side of the brachial 
artery, immediately where it has left the fold of the arm- 
pit. It passes downwards and backwards round the os 
humeri, and is accompanied by the musculo-spiral nerve. 
It passes betwixt the brachialis externus and short head 
of the triceps extensor cubiti. Here it lies deep among 
the muscles, and divides into two branches. One accom- 
panying the nerve spreads its ramification over the outer 
condyle, and anastomoses with the arteries below the 
elbow. The other branch is distributed along the inside 
of the arm, and about the inner condyle. 

2. A. Profunda Humeri Inferior, is smaller than 
the last, and is sent off from the brachial artery about 
two inches lower down. It descends among the muscles 
on the inside of the arm, and is lost about the inner 
condyle. 

8. The anastomosing or collateral arteries are as 
follows : — 

(1.) The Eamus Anastomoticus Major passes from the 
inside of the brachial artery, about two or three inches 
above the inner condyle. It is distributed about the 
condyle, and its principal branch accompanies the ulnar 
nerve in the groove betwixt the olecranon and inner con- 
dyle, to anastomose with the recurrent branches of the 
arteries of the forearm. 

(2.) Muscular Branches. 

The Brachial Artery, where it lies deep under the apo- 
neurosis of the biceps, divides into three branches. 1. 
The radial. 2. The ulnar; and 3. The interosseous artery. 
The two last generally come off by one trunk, which sub- 
divides. 

1. Arteria Eadialis. The radial artery is smaller 
than the ulnar, and in its course more superficial. It 
leaves the ulnar artery, and inclines towards the radial 
and outer edge of the forearm. At first it lies betwixt 
the pronator teres and supinator longus. It then descends 
close along the inner edge of the supinator longus, be- 
twixt the supinator longus and flexor carpi radialis, and 



ARTERIES OF THE FOREARM AND HAND. 137 

is accompanied by the radial nerve. Beaching the lower 
extremity of that bone, it divides into two branches. 

(1.) A. Superficialis Yol^ is by much the smallest 
of the two branches. It passes into the muscular mass 
which forms the ball of the thumb, anastomosing with 
the superficial palmar arch. 

(2.) The trunk of the radial artery crosses over the 
lower extremity of the radius to the back of the hand. 
It passes under the extensors of the thumb, and, arriving 
at the space betwixt the bases of the metacarpal bones of 
the thumb and fore-finger, plunges into the palm of the 
hand. 

Fig. 42. 
Arteries of the Forearm and Hand. 



1. Brachial Artery. 

2. Profunda Minor. 

3. Bifurcation of the Brachial into the 

Radial and Ulnar. 

4. Radial. 

5. Recurrens Radialis. 

6. Anterior Carpal. 

7. Dorsalis Carpi. 

8. Superficialis Volse. 

9. Arcus Profundus. 

10. Magnus Pollicis. 

11. Artery of the Thumb.. 

12. Radialis Indicis. 

13. Ulnar Artery. 

14. Recurrens Ulnaris. 

15. Anterior Interosseal. 

16. Cubitalis-manus Profunda, or Anasto- 

mosing Artery. 

17. Arcus Sublimis. 

18. Digital Arteries. 

19, 19. Digito-ulnar Arteries. 



The branches of the radial artery, in its course along 
the forearm, are the following : — 

(1.) The recurrent artery is sent off from the radial 
12* 




138 PRACTICAL ANATOMY. 

immediately after it leaves the ulnar artery, and is dis- 
tributed over the anterior part of the outer condyle, 
where it anastomoses with branches of the brachial 
artery. 

2. Muscular, to the muscles of the forearm. 

(3.) A branch leaves the artery immediately after it 
has turned over the edge of the radius, and, ramifying on 
the back of the hand, is named Dorsalis Carpi. 

(4.) Small vessels are sent off to the back part of the 
thumb, named A. Dorsales Pollicis. 

Having reached the palm of the hand, the radial artery 
divides into two branches. 

(1.) A. Pollicis, which sends two or three arteries along 
the anterior part of the thumb, and also often gives, off a 
twig, the A. Radialis Indicis, which passes along the outer 
edge of the fore-finger, and inosculates with a branch of 
the ulnar artery. 

(2.) The trunk of the radial artery forms the Deep- 
seated Palmar Arch. From the root of the thumb, it 
passes across the metacarpal bones near their bases, and 
terminates at the metacarpal bone of the little finger, in- 
osculating with a branch of the ulnar artery. This arch 
lies deep, close to the bones. It supplies the interosseous 
muscles and deep-seated parts of the palm, and some of 
its branches pass betwixt the metacarpal bones to the 
back of the hand. 

2. Arteria Ulnaris. The ulnar artery is the largest 
branch of the brachial, and generally gives off the inter- 
osseous artery. It takes its course deep among the 
muscles on the inside of the forearm. It is seen passing 
under the pronator teres, flexor carpi radialis, palmaris 
longus, and flexor sublimis perforatus, but over the flexor 
profundus perforans. It descends in the connecting cellu- 
lar membrane, between the flexor sublimis and profundus; 
but above the middle of the forearm, it emerges from 
these muscles, and appears at the ulnar edge of the arm, 
betwixt the flexor sublimis and flexor carpi ulnaris. It 
passes over the annular ligament of the wrist, but is 
covered by the fascia which ties down the tendon of the 
flexor carpi ulnaris. It passes under the palmar aponeu- 



ARTERIES OF THE FOREARM AND HAND. 139 

rosis, on the inside of the os pisi forme, reaches the base 
of the metacarpal bone of the little finger, and begins to 
form the Superficial Palmar Arch. This arch lies 
above the tendons of the flexor sublimis perforatus, imme- 
diately beneath the Palmar Aponeurosis. It crosses 
the metacarpal bones betwixt their bases and the middle 
of their bodies. It begins at the root of the little finger, 
and terminates at the root of the thumb, in inosculations 
with the branches of the radial artery. The convex side 
of the arch is turned towards the fingers, and sends off 
five branches. 

(1.) A branch to the muscles and inner edge of the 
little finger. 

(2.) Eamus digitalis primus, or the first digital artery, 
which runs along the space betwixt the two last meta- 
carpal bones, and bifurcates into two branches, one to the 
outside of the little finger > and the other to the inner side 
of the ring-finger. 

(3.) The second digital artery, which bifurcates in a 
similar manner, and supplies the outer edge of the ring- 
finger, and the inner side of the middle finger. 

(4.) The third digital artery, which is distributed to the 
outer edge of the middle finger, and to the inner side of 
the fore-finger. 

(5.) The ramus Pollicis ulnaris is the last branch 
of the ulnar artery, and is sent to the muscles of the 
thumb. 

From the concavity of the arch are sent off the inter- 
osseous arteries of the palm, small twigs which supply the 
deep-seated parts, and perforate betwixt the metacarpal 
bones to the back of the hand. 

The branches of* the ulnar artery, in its course along 
the forearm and wrist, are the following : — 

(1.) The Eecurrent Arteries are sent off from the 
ulnar artery immediately below the elbow. These arte- 
ries inosculate with branches of the brachial. 

(2.) Twigs to the muscles of the forearm. 

(3.) A. Dorsalis Carpi is sent off from the ulnar artery 
a little above the wrist to the back of the hand. 

(4.) A. Palmaris Profunda is sent off from the ulnar 



140 PRACTICAL ANATOMY. 

artery, on the inside of the os pisiforme. It passes into 
the flesh at the root of the little finger, and inosculates 
with the termination of the deep-seated palmar arch of 
the radial artery. 

3. Arteria Interossea (or Interossea Communis). 
This artery is generally sent off from the ulnar. It 
immediately divides into two branches. 

(1.) The external or posterior interosseous artery is the 
smallest branch. It passes through the upper part of 
the interosseous ligament, to supply the muscles on the 
posterior part of the forearm. It sends off the A. Eecur- 
rens Interossea, which ramifies on the middle of the back 
part of the elbow-joint. 

(2.) The internal or anterior interosseous artery descends 
close upon the middle of the interosseous ligament, giving 
twigs to the adjacent muscles. At the upper edge of the 
pronator quadratus, it perforates the membrane to the 
back part of the arm, and spreads its extreme branches on 
the wrist and back of the hand. 

Veins. 

The cutaneous veins have been already described. 

The brachial artery is accompanied by two veins, named 
Yenae Comites, or Satellites. These receive branches 
corresponding to the ramifications of the artery. 

Nerves. 

In the dissection of the axilla, we demonstrated the 
great axillary plexus, and traced its two first branches, 
the external scapular and circumflex nerves. See Fig. 20. 
The distribution of the five remaining branches of the 
plexus must now be described. 

(3.) The External Cutaneous Nerve (Musculo- 
cutaneus, or Perforans Casserii) is the third branch of 
the axillary plexus. It passes through the belly of the 
coraco-brachialis muscle. It continues its course betwixt 
the Biceps flexor cubiti and the Brachialis internus. It 
gives twigs to these muscles, and appears as a superficial 
nerve on the edge of the supinator longus. It runs over 



ULNAR NERVE. 141 

the outer condyle, and is distributed to the integuments 
on the outside of the forearm, and back of the hand. 

(4.) The Median Nerve accompanies the brachial artery 
to the bend of the elbow. In its passage down the arm, 
it lies before that vessel, but at the elbow is situated on. 
its inside. It gives off no branches until it has sunk 
under the aponeurotic expansion of the biceps flexor. 
Here it distributes many nerves to the muscles of the 
forearm, to the pronator teres, flexor carpi radialis, the 
flexors of the thumb and fingers, and the pronator quad- 
ratus. The trunk of the nerve perforates the pronator 
teres, passes betwixt the flexor digitorum sublimis and 
flexor profundus, and continues its course betwixt these 
muscles down to the wrist. Near the wrist it becomes 
more superficial, lying amongst the tendons of the flexors, 
and before it descends under the annular ligament, sends 
a superficial branch to the integuments and short muscles 
of the thumb. The nerve itself passes with the flexor 
tendons of the fingers under the annular ligament of the 
wrist, and appears on their outside, near the root of the 
thumb. It ramifies superficially in the hand, sending off 
four branches, which supply the thumb and all the fingers 
except the little finger and the ulnar side of the ring- 
finger. 

(5.) The Ulnar Nerve descends along the inside of 
the arm. It is at first situated immediately under the 
integuments, but below the middle of the arm is tied 
down by the intermuscular fascia. The nerve then runs 
between the inner condyle and the olecranon. After 
passing the condyle, it continues its course betwixt the 
two heads of the flexor carpi ulnaris, till it reaches the 
ulnar artery. It then accompanies the ulnar artery, lying 
on its inside, and running along the forearm betwixt the 
flexor ulnaris and flexor digitorum sublimis. It sends 
twigs to the neighboring muscles, and, when arrived near 
the wrist, divides into two branches. 1. The Smaller 
Branch, called Eamus posticus, passes under the tendon of 
the flexor carpi ulnaris, and over the lower end of the ulna, 
to be distributed to the back of the hand, and of the little 
and ring-fingers. 2. The continued trunk of the nerve 



142 PRACTICAL ANATOMY. 

passes, on the inside of the ulnar artery, over the annular 
ligament of the wrist. It passes under the palmar apo- 
neurosis, and divides into three principal branches. The 
first supplies the integuments and muscles on the ulnar 
edge of the hand, and the inner side of the little finger. 
The second is distributed to the outer side of the little 
finger, and inner side of the ring-finger. The third 
branch accompanies the deep seated palmar arch, and 
terminates in the short muscles of the thumb and fore- 
finger, communicating with the median nerve. 

(6.) The Musculo-Spiral Nerve (Kadial of some 
anatomists) passes from the axilla behind the os humeri, 
making a spiral turn round the bone to reach the outside 
of the arm. It first descends between the brachialis ex- 
ternus and short head of the Triceps extensor cubiti, ac- 
companying the arteria profunda humeri superior, and 
passing deep into the flesh of the arm. Before it makes 
this turn, it gives branches to the muscles, also a cuta- 
neous branch, which descends on the inside of the arm. 
From the back part of the arm the great trunk of the 
nerve is reflected spirally forwards. It is seen emerging 
betwixt the supinator longus and brachialis internus, 
seated deep and close to the bone. It descends betwixt 
these muscles, keeping close to the edge of the supinator 
longus. Immediately after passing the fold of the arm, 
it sends off a nerve, which descends, superficial, upon the 
radial edge of the forearm, as far as the wrist ; and, at 
this point, the trunk of the muscular nerve divides itself 
into two branches. The first, a large branch, perforates 
the supinator brevis, and supplies the extensor muscles 
of the hand and fingers. The second branch accompanies 
the supinator longus down the forearm, and near the 
wrist turns under the tendon of that muscle, over the 
edge of the radius. It then divides into several branches 
which ramify on the back of the wrist, thumb, and fore- 
finger. 

(7.) The Internal Cutaneous Nerve descends, super- 
ficial, along the inside of the arm and forearm. It was 
described among the cutaneous nerves of the arm. 



DISSECTION OF THE ABDOMEN, 



143 



CHAPTEE X. 
DISSECTION OF THE ABDOMEN. 



MUSCLES OF THE ABDOMEN, AND THE PARTS CONNECTED 
WITH THEM IN DISSECTION. 

Before commencing its dissection, study what are 
called its regions. To mark them out, drop a perpen- 
dicular from the anterior inferior spinous processes 
through the cartilages of the ribs. Then cross these two 

Fig. 43. 




The Abdominal Regions. 



1, 1. Hypochondriac Regions. 

2. Epigastric Region. 
3, 3. Lumbar Regions. 



4. Umbilical Region. 
5, 5. Iliac Regions. 

6. Hypogastric Region. 



lines by two others drawn the upper one through, the 
points where the first two touched the cartilages of the 
ribs, and the second from one anterior superior spinous 



144 PRACTICAL ANATOMY. 

process of the ileum to the other. These lines will define 
nine regions. Three in the centre, which, enumerated 
from above downwards, are the Epigastric, Umbilical, 
and Hypogastric. Three on either side, which from 
above downwards are the Hypochondriac, Lumbar, and 
Iliac Eegions. 

The muscles are ten in number, five on each side. 

An incision should be made through the integuments, 
from the sternum to the os pubis ; and this should be 
crossed bj another passing from the lower end of the 
sternum obliquely upwards towards the axilla; dissect 
off the layers in order and this will expose — 

In the superficial fascia of the abdomen an artery, ac- 
companied by its veins, the Superficial Epigastric, or 
Arteria ad cutem abdominis. 

1. The Obliquus Descendens Externus. — Origin: By 
eight triangular fleshy slips from the lower edges and 
external surfaces of the eight inferior ribs, at a little dis- 
tance from their cartilages ; the five superior slips meet 
on the ribs an equal number of the digitations of the 
serratus major anticus, and the three inferior are con- 
nected with the attachments which the latissimus dorsi 
has to the rib. To gain a complete view of this muscle, 
the neighboring portions of the pectoralis major, serratus 
anticus, and latissimus dorsi should be dissected with it. 

The muscular fibres proceed obliquely downwards 
and forwards, and about the middle of the side of the 
belly terminate abruptly in a thin broad tendon, which 
is continued in the same direction over all the forepart 
of the belly. Here it covers the anterior surface of the 
rectus abdominis ; it is very thin at the upper part, where 
the rectus lies on the cartilages of the ribs, and is often 
removed by the beginner, unless he is very cautious. ' 

Insertion: Tendinous and fleshy, into two anterior 
thirds of the outer edge of the crista of the os ileum, from 
the anterior superior spine of which, for it extends to the 
os pubis, forming Poupart's ligament, into the ensiform 
cartilage, and into the whole length of the linea alba. 

Use : To draw down the ribs in expiration, to bend the 
trunk forwards when both muscles act, or to bend it 



ANNULUS ABDOMINALIS. 145 

obliquely to one side when one of them acts singly; to 
raise the pelvis obliquely when the ribs are fixed ; to 
compress the abdominal viscera, to thrust the diaphragm 
upwards, to assist in the expulsion of the urine and feces, 
and of the foetus. 

In the course of the dissection of this single muscle, the 
following points must be attended to. 

The Linea Alba, a white line running along the 
middle of the abdomen, from the cartilago ensiformis to 
the os pubis ; formed by the tendinous fibres of the two 
obliqui and the transversalis muscles, interlaced with 
those of the same muscles on the opposite side ; it is half 
an inch broad at the navel; and decreases gradually both 
above and below that part ; but particularly in the latter 
situation, where it is reduced at last to a mere line. 

Linea Semilunaris, a semicircular white line, running 
from the os pubis obliquely upwards over the side of the 
abdomen, at the distance of about four inches from the 
linea alba ; formed by the tendons of the two oblique 
and transverse muscles uniting at the edge of the rectus, 
before they separate to form the sheath for that muscle. 

Line^e Transversa, three or four white lines, cross- 
ing from the linea semilunaris to the linea alba ; formed 
by the tendinous intersections of the recti shining through 
the strong sheath which covers them. These are not 
evident in all subjects in this stage of the dissection. 

Umbilicus, or Navel. This which, before the integu- 
ments were removed, was a depression, appears now a 
prominence ; it consists of condensed cellular membrane. 

Annulus Abdominalis, or King, an oblique slit or 
opening just above the angle of the pubis ; formed by the 
tendon of the external oblique, divided into two portions 
called the pillars or columns of the ring, of which one (the 
superior or internal) is attached to the symphysis, and the 
other (the inferior or external) to the tuberosity of the 
pubis ; and allowing a passage to the spermatic cord in 
the male, and the ligamentum teres of the uterus in the 
female. This slit is triangular ; the pubis is the base, the 
two columns are the two sides of the triangle. From the 
margins of the pillars a thin fascia is derived which 
13 



146 



PRACTICAL ANATOMY. 
Fig. 44. 




Dissection of some op the Parts concerned in Femoral and Inguinal 
Hernia. 

1. Tendon of the External Oblique Muscle. 

2. Tendon of the Internal Oblique, the first-named muscle being 

dissected off. 

3. Cribriform Fascia. 

4. Vena Saphena. 

5. External Abdominal Ring and Spermatic Cord. 

6. Poupart's Ligament. 



OBLIQUUS ASCENDENS 1NTERNUS. 147 

passes down upon the cord (the Intercolumnar or 
Spermatic Fascia). It forms a coating for an inguinal 
hernia. The apex has a rounded figure in consequence 
of some transverse fibres, which connect the two columns 
where they first separate ; and it points obliquely up- 
wards and outwards. It belongs to the external oblique 
alone, there being no such opening, either in the internal 
oblique, or the transversalis ; it is much smaller in the 
female than in the male. 

Ligamextum Poupartii, a strong ligament, stretching 
from the anterior superior spinous process of the os ilium, 
to be fixed to the spine of the os pubis. This in truth is 
merely the lower edge of the tendon of the obliquus 
externus abdominis, extended from the anterior superior 
spinous process of the ileum to the angle of the pubis. 
It covers the femoral vessels and nerves, and certain 
muscles, and has lately been often described under the 
name of the Crural Arch. 

Dissect off the serrated origin of the external oblique 
from the ribs and from the spine of the os ilium, and de- 
tach it from the obliquus internus, which lies below it, and 
which is connected to it by loose cellular substance, and 
by small vessels. Continue to separate the two muscles 
till you find their tendons firmly attached, i. e., a little 
way beyond the linea semilunaris. Separate the tendon 
from Poupart's ligament to within half an inch of the 
abdominal ring. 

2. Obliquus Ascendens Internus — Arises by short 
tendinous fibres, which soon become fleshy, from the 
whole length of the spine of the os ilium, and from the 
fascia lumborum ; also fleshy from the upper part of Pou- 
part's ligament at the part next to the os ilium. 

The fibres run in a radiated direction ; those which 
originate from the back part of the os ilium run ob- 
liquely upwards; those from the forepart of the ilium 
pass more transversely ; and from Poupart's ligament the 
fibres descend. The fleshy belly is continued rather more 
forward than that of the external oblique before it ter- 
minates in a flat tendon. 

Inserted into the cartilages of the six or seven lower 



M8 



PRACTICAL ANATOMY 

Fig. 45. 




The Muscles of the Anterior Aspect of the Trunk ; on the Left Side 
the Superficial Layer is seen, and on the Right the Deeper Layer. 



10. 
11. 

12. 
13. 

14. 



The Great Pectoral Muscle. 
The Deltoid Muscle. 

The Anterior Border of the Latissimus Muscle. 
The Indigitations of the Great Serratus Muscle. 
The Right Subclavian Muscle. 
The Small Pectoral Muscle. 
The Coraco-Brachialis Muscle. 

The Upper Part of the Biceps Muscle, showing its two heads. 
The Coracoid Process of the Scapula. 
The Great Serratus Muscle of the Right Side. 
The External Intercostal Muscle of the Fifth Intercostal Space. 
The External Oblique Muscle. 

Its Tendon or Aponeurosis ; on the left of this number is the semi- 
lunar line, and on the right the middle white line (linea alba). 
Poupart's Ligament or the Crural Arch. 



MUSCLES OF THE TRUNK. 149 

15. The External Inguinal or Abdominal Ring ; the crescentic opening 

to the right of 15 is the saphenous opening in the Femoral Apo- 
neurosis. 

16. The Rectus Abdominis Muscle of the Right Side brought into view 

by the removal of the anterior segment of the sheath formed by 
the tendons of the Broad Muscles of the Abdomen. 

17. The Pyramidal Muscle. 

18. The Internal Oblique Muscle. 

19. The Conjoined Tendon of the Internal Oblique and Transversalis 

Muscle. 

20. The Arch formed by the Lower Border of the Internal Oblique and 

Transversalis Muscles, from beneath which the Spermatic Cord 
has been removed. 

21. Fascia Lata Femoris. 

22. Saphenous Opening. 

The Crescentic Edge of the Sartorial Fascia is seen just above Fig. 22, 
and the Interior or Pubic Point of the Crescent is known as Hey's 
Ligament. 

ribs; fleshy into the three inferior, and, by a tendinous 
expansion, which is extremely thin, resembling cellular 
membrane, into the four superior, and also into the ensi- 
form cartilage. The sheet of tendon in which the fleshy 
belly ends is continued, single and undivided, into the 
linea semilunaris, where, adhering pretty firmly to the 
tendons of the obliquus externus and transversalis, it 
divides into two layers. The anterior and more consider- 
able layer joins the tendon of the external oblique, and 
runs over the rectus to be inserted into the whole length 
of the linea alba. The posterior and thinner layer, ad- 
hering to the anterior surface of the transversalis, passes 
into the linea alba behind the rectus as low as half way 
between the umbilicus and os pubis; but below this place 
the whole tendon of the internal oblique passes along 
with that of the external oblique before the rectus, and 
is inserted into the lower part of the linea alba. The 
inferior edge of the muscle extends in a nearly straight 
direction over the spermatic cord to be fixed by a tendi- 
nous attachment to the tuberosity of the pubis. 

Situation: It is covered by the obliquus descendens ex- 
ternus and latissimus dorsi. 

Use: To assist the obliquus externus; but it bends the 
trunk in the reverse direction, so that the muscle on each 

13* 



150 PRACTICAL ANATOMY. 

side co-operates with the obliquus externus of the oppo- 
site side. 

About the middle of Poupart's ligament, a delicate 
fasciculus of fibres is sent off from this muscle over the 
spermatic cord, where it passes under its edge in its way 
to the ring. This is named the 

Cremaster, and is continued down to the cord till it 
is insensibly lost on the tunica vaginalis testis. It will 
be seen in the dissection of the scrotum. It forms a 
covering for oblique inguinal hernia, as from what will 
be presently seen it overlies the inguinal canal. Its use 
is to suspend, draw up, and compress the testicle. 

We must now dissect the attachments of the internal 
oblique from the cartilages of the ribs, from the fascia 
lumborum, and from the spine of the os ilium, and, by 
continuing our dissection from behind forwards, separate 
it from the transversalis abdominis, which lies under it. 
This separation may be continued as far as where the 
tendons of the two muscles are inseparable, i. e., rather 
more forward than the linea semilunaris. As this muscle 
lies very close upon the transversalis, caution is required 
to avoid detaching both muscles together. Let the stu- 
dent begin his separation at the crista of the ilium, where 
the course of the Circumflexa Ilii Artery and Vein 
will show him when he has arrived at the surface of the 
transversalis. 

3. Transversalis Abdominis — Arises, tendinous, 
from the fascia lumborum and back part of the spine of 
the os ilium ; fleshy from all the remaining part of the 
spine of the ilium and from the inner surface of Poupart's 
ligament ; and fleshy from the inner or back part of the 
cartilages of the seven lower ribs, where its fibres meet 
those of the diaphragm. 

The fleshy fibres proceed transversely, and end in a 
flat sheet of tendon, which, after being connected to the 
other tendons at the linea semilunaris, passes with the 
posterior layer of the internal oblique behind the rectus, 
and is inserted into the ensiform cartilage, and into the 
whole length of the linea alba, excepting its lowermost 
part; for, at the middle distance between the umbilicus 



VENTRO-INGUINAL OR DIRECT HERXIA. 151 

and os pubis, a slit or fissure is formed in this tendon, 
through which the rectus abdominis passes ; and the re- 
mainder of the tendon passes before the rectus, to be 
inserted into the lower part of the linea alba. Its infe- 
rior edge is connected with that of the internal oblique 
muscle, and the two form a common tendon (the cox- 
joined tendon), which is inserted into the Linea Inno- 
MINATA, which would place it behind the external abdo- 
minal ring, and thus strengthen it. 

Use: To support and compress the viscera of the ab- 
domen. 

When the transversalis is detached from its origins, 
and turned back towards the linea semilunaris, it will be 
seen to be lined by a fascia, strongest near to Poupart's 
ligament, to which it is attached. This is named by Sir 
Astley Cooper, its discoverer, the Fascia Transver- 
salis, and prevents the bowels from being protruded 
under the inferior margins of the obliquus internus 
and transversalis muscles. It is perforated about the 
middle between the ilium and pubes, by an opening (In- 
ternal Abdominal King) for the passage of the sper- 
matic cord, which then goes obliquely downwards, in- 
wards and forwards to the ring of the external oblique. 
The space between this internal ring in the fascia trans- 
versalis and the external ring in the tendon of the external 
oblique is called the Inguinal Canal, and is traversed 
by an oblique inguinal hernia. If the cord be drawn 
out, the fascia transversalis follows, being prolonged into 
a funnel-shaped figure. This prolongation forms the In- 
fundibular Fascia of some, and is enumerated often 
as a covering of inguinal hernia. 

In Yentro-Inguinal or Direct Hernia, the intes- 
tine comes out only through the external ring instead of 
entering the canal at the internal ring ; and, as the Con- 
joined Tendon is inserted behind the external ring, it 
must carry this tendon before it, and will not receive a 
covering from the cremaster, as the cord which it overlies 
will be to the outer side of the tumor. 

The sheath of the rectus is now to be attended to ; it 
is formed by the tendons of the three other muscles, viz : 



152 PRACTICAL ANATOMY. 

the two obliqui and the transversalis. These, when they 
reach the edge of the rectus, form the appearance named 
Linea Semilunaris; they then split and inclose the rectus 
iu their duplicature ; the whole tendon of the external 
oblique, with the anterior layer of the internal oblique, 
passes before the rectus ; and the whole posterior layer 
of the internal oblique, together with the whole tendon 
of the transversalis muscles, pass behind the rectus, ex- 
cepting at the lower part ; but, for two or three inches 
above the pubis, all the tendons go in front of the muscle, 
and the posterior part of the sheath is consequently de- 
ficient, the rectus .lying naked on the peritoneum, or 
having a very thin expansion of the transversalis fascia. 

The two oblique muscles are now to be replaced; then, 
making an incision by the side of the linea alba, and thus 
opening the sheath of the rectus through its whole length, 
you dissect it back towards the linea semilunaris, and 
thus lay bare the fibres of the muscle next to be de- 
scribed. 

4. Rectus Abdominis — Arises, by a flat tendon, from 
the forepart of the os pubis ; as it ascends, its fleshy belly 
becomes broader and thinner. 

Inserted, by a thin fleshy expansion, into the ensiform 
cartilage, and into the cartilages of the three inferior true 
ribs. 

Situation: This pair of muscles is situated on each side 
of the linea alba, under the tendons of the oblique mus- 
cles. The muscle is generally divided by three tendinous 
intersections; the first is at the umbilicus, the second 
where it runs over the cartilage of the seventh rib, and 
the third in the middle between these; and there is com- 
monly a half intersection below the umbilicus. By these 
intersections, the muscle is connected firmly to the inte- 
rior part of its sheath, forming the Lineje Transversa, 
while it adheres very slightly by loose cellular substance 
to the posterior layer. 

Use: To compress the forepart of the abdomen, to bend 
the trunk forwards, or to raise the pelvis. 

On each side of the linea alba, and inclosed in the 



DISSECTION OF THE CAVITY OF THE ABDOMEN. 153 

lower part of the sheath of the rectus, is sometimes found 
a small muscle, named 

5. Pyramidalis. — Origin: Tendinous and fleshy, of 
the breadth of an inch from the os pubis, anterior to the 
origin of the rectus. 

Insertion : By an acute termination, near half-way be- 
tween the os pubis and umbilicus, into the linea alba and 
inner edge of the rectus muscle. 

Use : To assist the lower part of the rectus. 



dissection of the cavity of the abdomen. 

Make a longitudinal incision from the scrobiculus cor- 
dis to the umbilicus, and from that point an oblique inci- 
sion on each side towards the. anterior spinous process of 
the os ilium, forming thus three triangular flaps. In 
doing this, avoid cutting the intestines, by raising the 
muscles from them after the first puncture. 

Before you disturb the viscera, observe the general 
situation of those parts which appear on the first opening 
of the abdomen. 

1. The internal surface of the Peritoneum, smooth, 
shining, and colourless, covering the parietes of the abdo- 
men, and the surface of all the viscera. 

2. In the triangular portion of integument folded down 
over the pubes, three ligamentous cords project through 
the peritoneum, two running laterally, and the other in 
the middle, towards the navel. These are the remains of 
the two umbilical arteries and the urachus. 

3. The epigastric artery, accompanied by two veins, 
may be seen through the peritoneum, ascending obliquely 
upwards and inwards from under Poupart's ligament. 
From the external iliac artery, and its relation to the 
internal abdominal ring should be noted, being on its 
posterior wall; and, therefore, when a hernial stricture 
occurs here, the incision should be made upwards, to 
avoid it. Close along Poupart's ligament will be seen 
the Circumflex Ilii artery, running towards the crest 
of the ileum. It comes from the external ifcac artery. 

4. The upper edge of the liver is seen extending from 



154 PRACTICAL ANATOMY. 

the right hypochondriac region, across the epigastric, into 
the left hypochondriac region ; in it a fissure is seen, into 
which enters, inclosed in a dnplicature of peritoneum, the 
ligamentum teres, which was, in the foetus, the umbilical 
vein. The fundus of the gall-bladder, if distended, is 
sometimes seen projecting from under the edge of the 
liver. 

5. The Stomach will be found lying in the left hypo- 
chondriac region, and upper part of the epigastric ; but, 
if distended, it protrudes into the umbilical region. 

6. The Gee at Omentum proceeds from the great 
curvature of the stomach, and stretches down like a flap 
over the intestines.' 

7. The Great Transverse Arch of the Colon will 
be seen projecting through the omentum ; it mounts up 
from the os ileum of the right side, crosses the belly 
under the edge of the liver, and under the greater curva- 
ture of the stomach, and descending again upon the left 
side, sinks under the small intestines, and rests upon the 
wing of the left os ilium. 

8. The Small Intestines lie convoluted in the lower 
part of the belly, surrounded by the arch of the colon. 

Such is the general appearance on first opening the 
abdomen ; but this will vary somewhat, as one intestine 
may happen to be more inflated than another, or as the 
position of the body may have been after death. 

It will now be proper to consider the parts more mi- 
nutely. 

1. The Peritoneum. — Observe how it is reflected from 
the parietes of the abdomen over all the viscera, so that 
they may be said to be situated behind it; trace its reflec- 
tions from side to side, and from above downwards ; you 
will see that the external coat of every viscus, and all the 
connecting ligaments, are reflections or continuations of 
this membrane. 

(1.) The four Ligaments of the Liver are formed by 
the peritoneum, continued from the diaphragm and pa- 
rietes of the abdomen. 

a, The Middle or Suspensory Ligament, inclosing 
in its duplicate the Ligamentum Teres. 



REFLECTIONS OF THE PERITONEUM. 



155 



Fig. 46. 
Reflections of the Peritoneum. 

1. Liver. 

2. Stomach. 

3. Small Intestine. 

4. Arch of the Colon. 

5. Duodenum. 

6. Pancreas. 

7. Rectum. 

8. Uterus. 

9. Vagina. 

10. Bladder. 

11. Peritoneum reflected a little 

farther hack, from the Dia- 
phragm to the Liver, which 
last it covers above in front 
and below, and forms the 
Anterior Lamina of the 
Lesser Omentum. 

12. It then covers the anterior 

face of the stomach, and 
forms at 13 and 14 the an- 
terior layer of the omentum 
majus : at 
15. It is reflected upwards to 
form at 16 the posterior 
layer of that omentum ; at 
17. It embraces the colon on its 
posterior surface and forms 
the posterior lamina of the 
mesocolon at 18 ; it then 
passes in front of the duo- 
denum, 5, and descends to 
embrace the small intestine, 3, whence it is reflected upwards so as to 
give the posterior lamina to the mesentery, 19 ; it next passes down 
the posterior parietes of the abdomen, covers the rectum, 7, in front, 
the uterus, 8, the bladder, 10, and thence ascends to constitute the 
abdominal peritoneum, 20 and 21, lines the diaphragm, and terminates 
above in the coronary ligament of the liver at 22. If we now trace 
the peritoneum from the posterior margin of that ligament, 22, we find 
it coating the posterior face of the stomach, 1, and then separating from 
that organ to form the posterior lamina of the lesser omentum at 23 ; 
it next covers the posterior face of the stomach, 24, and is thence 
reflected downwards to constitute the posterior layer of the anterior 
fold of the greater omentum, 25, 26 ; after which it turns upwards and 
forms at 27 the anterior layer of the posterior fold of the greater 
omentum ; it then invests the front surface of the colon, 4, and forms 
at 28 the anterior face of the mesocolon ; it thence passes upwards in 
front of the pancreas, 6, and terminates where we began, at the poste- 
rior margin of the coronary ligament of the liver. 




156 PRACTICAL ANATOMY. 

h, The Coronary Ligament, connecting the upper 
surface of the Liver to the diaphragm. 

c, The Broad Ligament of the right side. 

d, The Broad Ligament of the left side. 

(2.) The Lesser Omentum, or Hepatico-Gastric 
Omentum, is formed by two laminae of peritoneum, pass- 
ing from the under surface of the liver to the lesser curva- 
ture of the stomach, and containing in its duplicate the 
vessels of the liver. 

(3.) The Great Epiploon, Gastro-Colic or Omentum 
Majus. — Observe, that the peritoneum, coming from both 
surfaces of the stomach, and from the spleen, proceeds 
downwards into the abdomen, and is then reflected back 
upon itself, till it reaches the transverse arch of the colon, 
where its laminae separate to invest that intestine. This 
reflection is named the Great Omentum ; it is a pouch or 
bag, composed of four laminae of peritoneum, and the 
opening into it is by the Foramen of Winslow: Observe 
the situation of this semilunar opening ; it is on the right 
side of the abdomen, at the root of the lesser lobe, or 
lobulus spigelii of the liver;, it leads under the lesser 
omentum, under the posterior surface of the stomach, but 
above the pancreas and colon, into the sac of the omen- 
tum ; — the omentum sometimes reaches to the lower part 
of the hypogastric region, sometimes not beyond the 
navel ; it contains in its duplicature more or less of adi- 
pose substance. 

(4.) The Mesentery. — Observe, that the peritoneum, 
reflected from each side of the vertebrae, proceeds for- 
ward, to connect the intestines loosely to the spine ; that 
it begins opposite to the first lumbar vertebra, crosses 
obliquely from left to right, and ends half-way between 
the last lumbar vertebra and the groin. At its com- 
mencement, it binds down the extremity of the duode- 
num, and it terminates where the head of the colon 
begins. The great circumference which is in contact 
with the intestines, is very much plaited or folded, and is 
several yards in length. Between the laminae of me- 
sentery, observe the Mesenteric Glands, the branches 
of the superior mesenteric artery ramifying and forming 



MESOCOLON — HEPAR, THE LIVER. 157 

arches; the mesenteric veins accompanying the arteries; 
the trunk of the lacteals, situated contiguous to the me- 
senteric artery on its left side. It may sometimes be in- 
flated by the blowpipe. Nerves also run in the mesen- 
tery, but are not easily demonstrated. 

(5.) The Mesocolon is similar to the mesentery, and 
connects, in like manner, the colon to the spine. 

2. Hepar, the Liver. — Situation: Partly in the right 
hypochondrium, which it fills up, reaching as low as the 
kidney of that side, partly in the epigastrium, and run- 
ning also some way into the left hypochondrium. 

Connected by its four ligaments to the inferior surface 
of the diaphragm, and by the lesser epiploon to the small 
curvature of the stomach : — The little epiploon should 
now be removed, to discover the different parts of the 
liver. 

Observe the superior or convex surface adapted to the 
arch of the diaphragm ; the inferior or concave surface 
resting on the stomach; — the posterior or thick edge 
lying against the vertebrae, and the anterior thin margin 
corresponding to the lower edge of the chest-; — Observe 
the three lobes of the liver; — the great or right lobe; 1 — 
the small or left lobe; — the lobulus spigelii; — the great 
fissure, separating the right and left lobe, and receiving 
the suspensory ligament, and the ligamentum teres ; — the 
cavity of the portae between the great lobe and lobulus 
spigelii ; — the fissure on the right side of the lobulus for 
the vena cava inferior, which fissure is almost a complete 
foramen;— the notch in the back-part for the vertebrae; 
— the depression in the right lobe for the gall-bladder. 
Observe the vessels in the cavity of the portae, the hepatic 
artery on the left side, the ductus communis choledochus 
on the right side, and betwixt, but at the same time 
behind them, the vena portae; they are all surrounded 
by a plexus of nerves. From the sympathetic and par 
vagum these vessels and nerves pass along the edge of 
the little omentum, surrounded and connected by adipose 

1 Two others are enumerated, the lobulus caudatus and quadratus. 
See Special Anatomy. 
14 



158 PKACTICAL ANATOMY. 

and cellular substance ; the part is called Capsula Glis- 
soni. Observe that the ligamentum teres was the umbi- 
lical vein of the foetus, entering the vena portae, and that 
the ductus venosus in the foetus (obliterated in the adult), 
leaving the vena portae, passed into one of the venae 
cavae hepaticae. 

3. Yesicula Fellis, the Gall-Bladder. — Situation: 
In the right hypochondrium, in a superficial depression 
on the under surface of the right lobe of the liver : it 
sends off the Ductus Cysticus, which, uniting with the 
Ductus Hepaticus, forms the Ductus Communis Cho- 
ledochus; this perforates the first curvature of the 
duodenum. 

4. Yentriculus, the Stomach. — Situation: In the left 
hypochondriac and epigastric regions: Connected to part 
of the interior surface of the diaphragm, to the concave 
surface of the liver by the little omentum, to the spleen 
by a reflection of peritoneum, and to the arch of the colon 
by the great omentum. Observe its greater curvature 
looking downwards, its lesser curvature looking upwards ; 
and its two lateral surfaces. In the living body, the 
greater curvature is turned forward, and a little down- 
ward, the lesser arch backward, i. e. towards the spine, 
while one of the lateral convex sides is turned upwards, 
and the other downwards. Observe the bulging ex- 
tremity on the left side, the cardia or upper orifice, where 
the oesophagus enters half-way between this great ex- 
tremity and the lesser arch : the pylorus, or lower orifice, 
at the end of the small extremity, situated under the 
liver, and rather to the right side of the spine, feeling 
hard when touched. A constriction may be seen where 
the stomach ends in the duodenum, it marks the position 
of the pyloric valve on the inside. 

5. The Intestines. — These form one continuous tube, 
but are divided into two portions, differing in their figure, 
structure, and functions, and distinguished by the names 
of small and large. 

The small intestine is divided into duodenum, jejunum, 
and ileum; the large into caecum, colon, and rectum. 



UNDER OR CONCAVE SURFACE OF THE LIVER. 159 

Fig. 47. 

3 

*ff ?8 s*r 3 




10. 



11. 

12. 

13, 14. 

15. 

16. 
17. 

18. 
19. 
20. 
21. 
22. 
23. 
24. 
25. 
26. 
27. 



JZT32. 

Under or Concave Surface of the Liver. 

Right Lobe. 

Left Lobe. 

Its Anterior or Inferior Edge. 

Its Posterior or Diaphragmatic Portion. 

Right Extremity. 

Left Extremity. 

Notch in the Anterior Margin. 

Umbilical or Longitudinal Fissure. 

Round Ligament or remains of the Umbilical Vein. 

Portion of the Suspensory Ligament in connection with the 

Round Ligament. 
Pons Hepatis, or Band of Liver across the Umbilical Fissure. 
Posterior End of Longitudinal Fissure. 
Attachment of the obliterated Ductus Venosus to the Ascending 

Vena Cava. 
Transverse Fissure. 
Section of the Hepatic Duct. 
Hepatic Artery. 
Its Branches. 
Vena Portarum. 

Its Sinus, or Division into Right and Left Branches. 
Fibrous Remains of the Ductus Venosus. 
Gall-bladder. 
Its Neck. 
Lobulus Quartus. 
Lobulus Spigelii. 
Lobulus Caudatus. 
Inferior Vena Cava. 



160 PKACTICAL ANATOMY. 

28. Curvature of Liver to fit the Ascending Colon. 

29. Depression to fit the Right Kidney. 

30. Upper Portion of its Right Concave Surface over the Renal 

Capsule. 

31. Portion of the Liver uncovered by the Peritoneum. 

32. Inferior Edge of the Coronary Ligament in the Liver. 

33. Depression made by the Vertebral Column. 

(1.) Small Intestine; — about four times the length of 
the body. 

o, The Duodenum is broader than any other part of 
the small intestine, but is short ; it takes a turn from the 
pylorus upwards, and to the right side, passing under the 
liver and gall-bladder; then, turning upon itself, it de- 
scends, passing as low as the right kidney; it is in this 
space that it receives the pancreatic and gall ducts ; thence 
it crosses before the renal vessels, before the aorta, and 
upon the last dorsal vertebra, firmly bound down by the 
peritoneum, which covers only its anterior surface; it 
then ascends from right to left, till it is lost under the 
root of the mesocolon. 

Turning back the colon and omentum, fixing them 
over the brim of the thorax, and pushing down the small 
intestines towards the pelvis, you find the duodenum 
coming out from under the mesocolon, but still tied close 
to the spine; it terminates in the jejunum, exactly where 
the mesentery begins. The intestine in this course forms 
nearly a circle, the root of the mesocolon being the only 
part lying between its two extremities. 

You have now to trace the rest of the small intestine, 
which lies convoluted in the umbilical and hypogastric 
regions. 

b, Jejunum constitutes the first or upper half of the 
remaining small intestine, and is situated more in the 
upper part of the abdomen ; it is redder, and its coats 
feel thicker to the touch, from the greater number of the 
valvuke conniventes on its inner surface; its diameter 
exceeds that of the ilium. 

c, The lower half is named Ileum ; it is situated more 
in the lower part of the abdomen, and terminates in the 
great intestine, by entering the caput coli, or beginning 
of the colon. 



DIGESTIVE TUBE. 
Fig. 48. 



161 




The Digestive Tube, from the (Esophagus to the Anus. 

1. (Esophagus, which, is laid open at 2, to show its termination 
in the cardiac orifice of the stomach. 

3. Interior of the Stomach with its rugae. 

4. Duodenum, commencing at the Pylorus. 

5. Gall-bladder with the Cystic Duct, which last passes down- 

wards to open into the duodenum. 
6, 6, 6. Small Intestine, terminating in 7, the Caecum. 

8. Appendicula Vermiformis. 

9. Right ascending Colon. 

10. Transverse Arch of the Colon. 

11. Left descending Colon. 13. Rectum. 

12. Sigmoid Flexure. 14. Anus. 

14* 



l(te PRACTICAL ANATOMY. 

As a general observation it may be said that the con- 
volutions of the small intestine occupy the middle of the 
umbilical and Irypogastric regions; but their situation 
varies much, particularly according to the state of the 
bladder and rectum. The course of the tube, independ- 
ently of its convolutions, is from the left lumbar region, 
where the duodenum emerges from under the mesocolon 
to the right inguinal region, where the ileum terminates 
in the caput coli. Here a duplicature of the internal 
membrane into two folds, forms the ilio-colic valve. 

(2.) Great intestine. 

d, The Cecum, or blind gut, is tied down by the peri- 
toneum to the loins on the right side, lying in the space 
under the right kidney, hid by the convolutions of the 
ileum. On its posterior part there is a little appendage, 
of the shape of an earth-worm, named Appendix Cceci 

Vermiformis. 

e, The Colon. — Its commencement at the Caecum is 
termed Caput Coli, or head of the colon ; it mounts up- 
wards from the cascum over the anterior surface of the 
right kidney, passes under the gall-bladder, which, after 
death, tinges it with bile; and then, going across the 
upper part of the belly, forms its Great Transverse 
Arch. In its whole course it is contracted into cells by 
its muscular fibres, which are united together, forming 
longitudinal bands ; and it has some fatty projections 
attached to its surface, named Appendices Epiploicas. 
Both these circumstances distinguish the large from the 
small intestine; which the difference of size does not 
always. The colon then goes backwards under the sto- 
mach and spleen into the left hypochondrium ; and then, 
descending over the left kidney, it is again tied down ; 
it afterwards turns over the brim of the pelvis, being at 
this part unconfined, and forming a loose and remarkable 
curvature, which is named the Sigmoid or Iliac Flex- 
ure. After this convolution, the intestine assumes the 
name of 

The Eectcjm. — Drawing aside the intestines, you find 
the gut continued over the anterior surface of the sacrum 
and os coccygis to the anus. 



PANCREATIC DUCT. 
Fig. 49. 



163 




iLEO-CiECAL Valve. 



a. The Terminal Part of the Ileum, d. 

b. The Ileo-Caecal Valve. e. 

c. The Caecum. 



The Appeudieula Vermiformis. 
The Commencement of the 
Colon. 



On pulling the stomach towards the right side, yon will 
perceive 

6. The Lten, or Spleen. — Situation : In the left hypo- 
chondriac region, between the great extremity of the 
stomach, and the neighboring false ribs, nnder the edge 
of the diaphragm, to all of which it is connected by the 
peritoneum. It is of an oval figure ; its external surface 
is gently convex ; its internal surface irregularly concave, 
and divided by a longitudinal fissure, into which its 
vessels enter. 

7. The Pancreas. — Situation : This gland was in part 
seen on removing the little epiploon ; it is more fully ex- 
posed by tearing through the great epiploon, between the 
great curvature of the stomach and the transverse arch 
of the colon. It lies in the cavity into which the foramen 
of Winslow leads ; it extends from the fissure of the 
spleen across the spine, under the posterior surface of the 
stomach, and terminates within the circle formed by the 
duodenum ; it is only covered on its anterior surface by 
the peritoneum. 



164 PRACTICAL ANATOMY. 

The Pancreatic Duct pierces the coat of the duode- 
num, and enters the cavity of that intestine by an orifice 
common to it, and to the ductus communis choledochus. 
The duct runs along the very centre of the gland, where 
the whiteness of its coats will readily enable the student 
to distinguish it. 

All the abdominal viscera may now be removed, ex- 
cept the rectum, where it descends into the pelvis, which, 
being tied, should be allowed to remain, for it belongs to 
the demonstration of those parts ; or the liver and its ves- 
sels, with the pancreas, may be left, and the vessels enter- 
ing the portae of the liver traced. 

The student should open different portions of the intes- 
tine, and mark the folds of the mucous membrane, Val- 
vule Conniventes; also, the small eminences over 
those folds ; Villi. He should also examine the Pylo- 
ric Yalve; the Ileo-C^cal Yalve, at the termination 
of the ileum. Little bodies are frequently seen under 
the mucous membrane of the duodenum, the Glands of 
Brunner, and other patches of ductless glands in the 
ileum, the Glands of Peyer. 

The peritoneum should now be carefully dissected from 
the diaphragm, and from the sides and back part of the 
abdomen ; thus the parts which lie more immediately be- 
hind that membrane may be examined. 

8. Eenes, the Kidneys. — Two glandular bodies, 
situated in the posterior part of the cavity of the abdo- 
men, on each side of the lumbar vertebrae, between the 
last false rib and the spine of the ileum, and imbedded in 
a quantity of adipose membrane. 

Observe the renal or emulgent artery entering the vein 
and ureter passing out of its fissure. Observe the course 
of the ureter ; it passes behind the peritoneum over the 
psoas muscle into the pelvis, and runs between the rec- 
tum and bladder, which last it enters. 

If the kidney be laid open from its convex to its con- 
cave margins, the following points may be observed: 
An exterior or Cortical Portion ; an internal, which 
being arranged in cones, formed of uriniferous tubes, 
the Tubular or Conical part. These cones look into 



PIAPHRAGMA OR MIDRIFF. 



165 



three cavities, Infundibula, and these again into the 
Pelvis, and this into the ureter. 



Fig. 50. 
Longitudinal Section of the Kidney, with its Renal Capsule. 



1. Renal Capsule. 

2. Cortical or vascular part of the 

Kidney. 

3, 3. Uriniferous Tubes collected in- 

to conical Fasciculi. 

4, 4. Papillae, projecting into their 

corresponding calices. 
5, 5, 5. The three Infundibula. 

6. Pelvis of the Kidney. 

7. Ureter. 




9. The Capsule Kenales. — Two glandular bodies, 
situated on the upper extremity of each kidney, of an 
irregular figure, crescent-like, or somewhat triangular. 

By the removal of the peritoneum, several muscles are 
exposed, situated at the superior and posterior parts of 
the abdomen. 

One single muscle is situated in the superior part of 
the abdomen. 

Diaphragma, the Diaphragm, or Midriff. — This is 
a broad, thin, muscular septum between the thorax and 
abdomen, situated obliquely ; it is concave below, and 
convex above, the middle of it on each side reaching as 
high within the thorax as the fourth rib. It is divided 
into two portions. 

1. The superior or greater muscle of the diaphragm, 



166 PRACTICAL ANATOMY. 

forms the transverse partition between the chest and ab- 
domen, 

Arising, by distinct fleshy fibres, 1. From the posterior 
surface of the ensiform cartilage; 2. From the cartilages 
of the seventh, and all the false ribs ; 3. From the liga- 
mentum arcuatum, which is a ligament extended, some- 
what indistinctly, from the top of the twelfth rib to the 
lumbar vertebrae, forming an arch over the psoas and 
quadratus lumborum muscles. From these origins the 
fibres run, in different directions, like radii from the cir- 
cumference to the centre of a circle, and are 

Inserted into a broad tendon {tendinous centre, or cordi- 
form tendon), which is situated in the middle of the dia- 
phragm, and in which, therefore, the fibres from the 
opposite sides are interlaced. 

2. The inferior or lesser muscle, or appendix of the 
diaphragm, lies on the bodies of the vertebrae, and 

Arises, by four small tendinous feet, on each side, from 
the second, third, and fourth lumbar vertebras; these 
tendons soon join, to form a strong pillar on each side, 
named the Cms of the Diaphragm. The crura run 
obliquely upwards and forwards, form two fleshy bellies, 
a fasciculus of each of which crossing over to the other, 
decussates with the opposite one, and thus forms the 
interval of the two crura into a superior and inferior 
opening. 

Inserted into the posterior part of the middle cordiform 
tendon. 

Situation: The diaphragm is covered on its superior 
surface by the pleura, and on its inferior by the perito- 
neum ; it separates the thoracic from the abdominal 
viscera : It is perforated in its fleshy and tendinous parts 
by several bloodvessels, and other important organs. 

(1.) The aorta passes between the tendinous part of the 
crura, lying close upon the spine ; and the thoracic duct 
passes betwixt the aorta and the right crus. 

(2.) A little above, and to the left side of the aorta, 
the oesophagus, with the eight pair of nerves attached to 
it, passes through an oval fissure formed in the fleshy 
columns of the inferior muscle. 



THE DIAPHRAGM. 



167 



(3.) The vena cava perforates the tendon towards the 
right side. 

Fig. 51. 




The Diaphragm. 



1, 2, 3. Tendinous Centre of the 
Greater Diaphragm. 
5, 6. Ligamentum Arcuatum. 

7. Foramen of the Lesser 

Splanchnic Nerve. 

8. Right Crura of Diaphragm. 

9. Fourth Lumbar Vertehra. 
10. Left Crura of Diaphragm. 



11. Hiatus Aorticus. 

12. Foramen QSsophagenum. 

13. Foramen Quadratum, for the 

Passage of the Vena Cava. 

14. Psoas Muscle. 

15. Quadratus Lumborum. 

16. Transverse Processes of the 

Lumbar Vertebrae. 



(4.) The great splanchnic nerve, and branches of the 
vena azygos vein, perforate some of the posterior fibres 
of the crura. The lesser splanchnic nerve also passes 
through an opening in the substance of the crura. 

(5.) On each side of the sternum there is a small fissure, 
where the peritoneum and pleura are only separated by 
adipose membrane. 

Use: The diaphragm is one of the chief agents in 
respiration ; it also aGts in coughing, laughing and speak- 
ing, and in the expulsion of the urine and feces, &c. 



168 



PKACTICAL ANATOMY. 



Four pair of muscles are situated within the posterior 
part of the cavity of the abdomen. 

1. The Psoas Parvus, often wanting. — It arises, fleshy, 
from the sides of the last dorsal, and first lumbar verte- 
bras; it sends off a small long tendon, which, running on 
the inside of the psoas magnus, is 

Inserted, thin and flat, into the brim of the pelvis, at the 
junction of the os ilium and pubis. 

Use; To assist the psoas magnus in bending the loins 
forward. 

2. The Psoas Magnus. — It arises, fleshy, from the 

Fig. 52. 




1. Small Psoas Muscle. 

V. Insertion of the Tendon of the same into the Iliac Fascia cut. 

2. Great Psoas Muscle. 

3. Quadratus Lumborum Muscle, partly concealed by the two Psoas 

Muscles. 
3'. Same of the Right Side entirely exposed. 

4, 4. Foramina formed by the Grooves upon the Bodies of the Lumbar 

Vertebrae, and the Origins of the Great Psoas Muscle, for the 
passage of the Lumbar Arteries and Veins. 

5, 5. Inter-Transverse Muscles. 

6. Iliac Muscle entirely exposed by the removal of '2, Great Psoas 
Muscle cut. 



ILIACUS INTEKNTS. 169 

side of the body, and transverse process of the last verte- 
bra of the back, and in the same manner from all those 
of the loins, by as many distinct slips. It runs down 
over the brim of the pelvis, and is 

Inserted, tendinous, into the trochanter minor of the os 
femoris, and fleshy, into that bone immediately below the 
trochanter. 

Situation: It is situated betwixt the psoas parvus and 
iliacus internus. 

Use: To bend the thigh forwards, roll it outwards; or, 
to assist in bending the body. 

3. The Iliacus Inteknus. — It arises, fleshy, from the 
transverse process of the last vertebra of the loins, from 
all the inner margin of the spine of the Os ileum, from 
the edge of that bone between its anterior superior 
spinous process and the acetabulum, and from all its 
hollow part between the spine and the linea innominata. 
Its fibres descend under the outer half of Poupart's 
ligament, and join the tendon of the psoas magnus. 

Inserted with the psoas magnus. 

Situation : It fills up the internal concave surface of the 
os ileum. It is covered by a pretty strong fascia, which 
is inserted into the crista of the ileum, and into the crural 
arch : Fascia lliaca: at which point it joins the Fascia 
Transversalis. This Iliac Fascia passes under the iliac 
bloodvessels into the pelvis. The latter insertion pre- 
vents the bowels from descending under Poupart's liga- 
ment, except at the inner edge of the iliac vein, which is 
accordingly the situation of a crural hernia, and which 
the student should examine most carefully. A part of 
this fascia is also continued behind the femoral vessels 
over the pubis, to form a part of the sheath which 
incloses those vessels. A short distance to the pubic 
side of the iliac vein, a strong semilunar tendinous edge 
is seen ; this is one of the attachments of Poupart's liga- 
ment to the linea innominata, and is called Gimbernats 
ligament. Between this and the femoral vein, is a space 
filled by a lymphatic gland, and cellular tissue. The last 
called the Septum Grurale. This space is the Femoral or 
Crural ring, and is the place where an intestine sometimes 
15 



170 PRACTICAL ANATOMY. 

passes through, forming Femoral Hernia: The septum 
crurale would form one of its coverings. Kemember 
these points, and apply them when conducting the dis- 
section of the thigh. 

Use: To assist in bending the thigh, and in bringing 
it directly forwards. 

N. B. The insertion of the two last described muscles 
cannot be seen till the thigh is dissected. 

4. The Quadratus Lumborum.— This muscle arises, 
tendinous and fleshy, from rather more than the posterior 
third part of the spine of the os ileum. 

Inserted into the transverse processes of all the verte- 
brae of the loins, into the posterior half of the last rib, 
and, by a small tendon, into the side of the last vertebra 
of the back. 

Situation : It is situated laterally at the lower part of 
the spine, more outwardly than the psoas magnus. 

Use : To move the loins to one side, pull down the last 
rib. If both act, to bend the loins forwards. 

OF THE VESSELS AND NERVES SITUATED BEHIND THE 
PERITONEUM. 

1. The Arteries, viz: The Aorta Abdominalis, and its branches. 

The Aorta passes from the thorax into the abdomen, 
between the crura of the diaphragm, close upon the spine. 
It then descends on the forepart of the vertebras, inclined 
to the left side. On the fourth lumbar vertebra, it bifur- 
cates into the two primitive or common iliac arteries. 

Branches of the Abdominal Aorta. — 1. The two 
Phrenic Arteries arise from the Aorta, before it has 
fairly entered into the abdomen, and ramify over the 
diaphragm. 

2. The Cceliac Artery or Axis comes off at the point 
where the aorta has fairly extricated itself from the dia- 
phragm, surrounded by the meshes of the semilunar 
ganglion. It divides into three branches. 

(1.) A. Gastrica, smallest of the three. It passes along 
the lesser curvature from left to right, to inosculate with 
the pylorica or coronaria dextra. 



AORTA AND ITS BRANCHES. 
Fig. 53. 



171 




Abdominal Portion of the Aorta and its Branches. 



1. Aorta. 
2, 2. Primitive Iliac Arteries. 

3. Coeliac Artery cut across. 

4. Superior Mesenteric cut. 

5. Inferior Mesenteric cut. 

6. Middle Sacral. 

7, 7. Diaphragmatic or Phrenic 
Arteries. 



8, 8. Renal Arteries. 

9, 9. Spermatic Arteries. 

10. Lumbar Arteries. 

11. External Iliac Artery. 

12. Internal Iliac Artery. 
13, 13. Epigastric Artery. 

14. Circumflex Iliac Artery. 

15, 16. Musculo-cutaneous Nerves. 



172 PRACTICAL ANATOMY. 

(2.) Arteria Splenica passes under the stomach, and 
along the upper border of the pancreas ; it enters the 
spleen, and gives off the following branches : — 

a, Pancreatic^e Parvus to the pancreas, where it runs 
along the border of that viscus. 

bj Vasa Brevia to the bulging extremity of the 
stomach. 

c, A. Gastro-Epiploica Sinistra, along the greater 
curvature of the stomach, inosculating with the gastro- 
epiploica dextra. 

(3.) Arteria Hepatica runs to the liver. It sends off 
the following branches : — 

a, Pylorica. — It sends its ramifications along the lesser 
curvature, to inosculate with the proper coronary artery. 

b : Gastro-epiploica Dextra, or Gastro-duodenalis, 
passes under the pylorus, and along the great curvature 
of the stomach, inosculating with the gastro-epiploica 
sinistra (from the splenic), and sends off a branch to the 
pancreas. 

The hepatic artery then divides into the right and left 
hepatic. The Eight is distributed to the right lobe of 
the liver, and to the gall-bladder. The Left supplies the 
whole of the left lobe, the lobulus Spigelii, and part of 
the right lobe of the liver. 

3. The Superior Mesenteric Artery. — It leaves the 
aorta about half an inch lower than the coeliac artery ; it 
enters the fold of peritoneum forming the mesentery, and 
runs down in this, incurvating from the left to the right 
side. 

From the right side or concavity of this arch, three 
branches are given to the colon. 

(1.) A. Ileo-Colica to the caput coli and last of the 
ileum. 

(2.) A. Colica Dextra to the right side of the colon. 

(3.) A. Colica Media to the arch of the colon. 

The convexity of the arch of the superior mesenteric 
sends off' from sixteen to twenty branches, which, forming 
frequent anastomoses and arches, proceed to the small 
intestines. 

4. The Eenal or Emulgent Arteries are two in 



THE SEVERAL PARTS OF THE LARGE INTESTINE. 173 
Fig. 54. 




The Several Parts of the Large Intestine. 

a. The Caecum. 

b. Right or Ascending Colon. 

c. Transverse Colon, or Arch of the Colon. 

d. Left or Descending Colon. 

e, e. Sigmoid Flexure of the Colon. 

f. Rectum. 

g. Mesocolon. 

h. The end of the Ileum, or its termination at the Ileo-caecal 

"Valve. 
*. Appendicula Vermiformis. 
k. Pouch of the Rectum. 
I. Anus. 
m. Appendices Epiploic*, s 

15* 



174 PRACTICAL ANATOMY. 

number. Below the superior mesenteric, pass to the 
kidney. The right artery longer than the left, and passes 
behind the vena cava ascendens. 

5. The Spermatic Arteries are also two ; they come 
off an inch, below the emulgent from the forepart of the 
aorta. Each artery descends in its conrse, accompanied 
by the spermatic vein and nerves. It passes throngh the 
abdominal rings, and enters the upper part of the testicle. 
In the female it supplies the ovaria and fundus uteri. 

6. The Inferior Mesenteric is a single trunk. 
Comes off rather from the left side of the aorta, below the 
spermatic arteries ; it passes in the mesentery to the left 
side of the abdomen, where it divides as follows : — 

(1.) The Colic a Sinistra. To the left side of the 
colon. Inosculates with, the A. Colica Media. 

(2.) Branches which pass to the sigmoid flexure. 

(3.) The great trunk of the artery runs down to the 
rectum, on which it ramifies. Is termed Art. Hemor- 
rhoidals Superius. 

7. The Lumbar Arteries are five or six small arteries 
on each side, which arise from the back part of the aorta, 
and are distributed to the spinal canal, muscles of the 
spine, and of the sides of the abdomen and pelvis. 

8. A. Sacra Media is a single artery, arises from the 
back part of the aorta at its bifurcation, and descends 
along the anterior surface of the sacrum, giving twigs to 
all the neighboring parts. 

At the fourth lumbar vertebra, the aorta bifurcates 
into the two primitive or common iliacs. 

The Iliaca Communis runs along the edge of the 
psoas muscle, and at an inch or two from its origin di- 
vides into — 

(1.) The Internal Iliac which passes down into the 
pelvis. 

(2.) The External Iliac, which following the direction 
of the psoas muscle, passes under Poupart's ligament, and 
becomes the Femoral artery. 



VEINS. 175 

2. Veins. 

The Vena Cava Abdominalis, vel Inferior, is formed 
by the junction of the two common iliac veins; it passes 
up through the abdomen on the right side of the aorta. 

In this course it receives the following veins, which 
resemble their corresponding arteries : — 

1. The Lumbar Yeins. 

2. The Emulgent or Eenal "Veins: — the left is the 
longest, as it crosses over the forepart of the aorta. 

3. The Eight Spermatic Yein ; — the left enters the left 
renal vein. 

The vena cava then passes through the fissure of the 
liver, being nearly surrounded by that viscus, and re- 
ceiving three branches from it, called the Ven^: He- 
PATiciE. It then perforates the diaphragm, and enters 
the thorax. 

The common iliac vein of each side is formed by the 
union of two branches, the External and Internal 
Iliac Veins, which accompany the arteries of the same 
name : — The common iliac vein of each side lies on the 
inside of its artery ; hence both veins cross behind the 
right iliac artery, to unite and form the vena cava, on the 
forepart of the lumbar vertebrae. 

do not join the cava, but 

are united behind the 

The Superior Mesen- Pf^eas to form the 

terio Vein, the Inferior , Vena , Porte - T ^f ve, £ 

Mesenteric Vein, and the ^ ™ m } T t n'T 
o T T7 - T ' the liver, and its blood is 

Splenic Vein, , ,■' . . ,, 

returned into the vena 

cava by the venae cavae 

hepaticae. 

Although the trunks just enumerated are the chief 
veins that contribute to form the vena portas, yet the 
returning veins of all the viscera inclosed in the peri- 
toneum, except the liver, are included in the same system, 
and join one or other of the large trunks. This is the 
case with the stomach, pancreas, gall-bladder and omen- 



176 PRACTICAL ANATOMY. 

turn. The blood which goes to the spleen, large and 
small intestines, is all returned by the three great trunks. 

3. Nerves. 

1. The eighth pair, or Par Vagum, descending on each 
side of the oesophagus through the diaphragm, forms the 
two Stomachic Plexuses on the anterior and posterior 
surfaces of the stomach. These plexuses send some 
branches to the coeliac, to the hepatic, and to the splenic 
plexus. 

2. The Splanchnic Nerve, or Anterior Intercostal, a 
branch sent off by the intercostal nerve in the thorax, 
enters the abdomen betwixt the crura of the diaphragm; 
here each nerve forms a Semilunar Ganglion by the 
side of the coeliac artery. 

From the ganglion on each side branches are sent 
across, which communicate intimately together, and form 
round the root of the coeliac artery, a very intimate 
plexus, containing several ganglia of various sizes, for- 
merly called the Solar or Celiac Plexus. Nerves 
pass from this plexus, with the branches of the aorta, to 
the various viscera of the abdomen ; they form the He- 
patic, Splenic, Superior and Inferior Mesenteric, 
Eenal, and Spermatic Plexuses. 

3. The trunk of the sympathetic nerve (the posterior) 
perforates the diaphragm close to the spine, and runs along 
the upper edge of the psoas magnus. It terminates on 
the extremity of the os coccygis by union with the nerve 
of the opposite side, in a ganglion (Ganglion Impar). 
In this course, it communicates with the lumbar nerves 
and the various abdominal plexuses. 

The Thoracic Duct may be seen passing from the ab- 
domen into the thorax, between the aorta and the right 
crus of the diaphragm. It is larger here than in its sub- 
sequent course. It empties into the junction of the left 
subclavian and internal jugular veins. 



FASCIA LATA. 177 



CHAPTEE XII. 

DISSECTION OF THE ANTERIOR PART OF THIGH. 

Carey an incision from the middle of Poupart's liga- 
ment obliquely across the thigh, and aronnd the internal 
condyle of the femur to the tubercle of the tibia. Eeflect 
the integuments. The superficial fascia, especially at the 
groin, is lamellated ; and situated in it about Poupart's 
ligament a cluster of lymphatic glands. In and beneath 
this fascia notice, 

1. The Vena Saphena Major, seen running up in 
the inside of the knee and thigh. At first it lies very 
superficial, betwixt the skin and fascia lata. As it ascends 
it is gradually enveloped by the fibres of the fascia, and 
then sinks beneath it to join the femoral vein about an 
inch below Poupart's ligament. The space through which 
it sinks to join the femoral vein is the Saphenous Open- 
ing, and the loose cellular tissue which envelops the. vein 
and occupies the opening is called the Cribriform Fas- 
cia. In its course it is joined by several cutaneous 
veins. 

2. Immediately under the true skin you may occasion- 
ally perceive the Lymphatic Vessels running, like lines 
of a whitish color, to enter the inguinal glands. 

3. Several Cutaneous Nerves are seen ramifying 
above the fascia. They all come from the lumbar nerves 
or anterior crural nerve. 

The deep fascia, or Fascia Lata, may now be exposed 
distinctly by carefully clearing away the superficial fas- 
cia ; preserving, however, the saphena vein, a short dis- 
tance down. Observe how extensively it arises from the 
bones, tendons, and ligaments. On the anterior and su- 
perior part of the thigh, it arises from Poupart's ligament, 



178 



PRACTICAL ANATOMY. 




Dissection of some op the Parts concerned in Femoral and Inguinal 
Hernia. 

1. Tendon of the External Obliqne Muscle. 

2. Tendon of the Internal Oblique, the first-named muscle being 

dissected off. 

3. Cribriform Fascia. 

4. Vena Saphena. 

5. External Abdominal Ring and Spermatic Cord. 

6. Poupart's Ligament. 



DISSECTION OF ANTERIOR PART OF THIGH. 179 

from the os pubis, from the descending ramus of that 
bone, and from the ascending ramus and tuberosity of the 
ischium; behind, and on the outside, from the whole 
spine of the ileum, and from the sacro-sciatic ligaments. 
It receives a number of fibres from a muscle belonging 
to it, viz., the tensor vaginae femoris, and from the tendon 
of the gluteus- maxim us; it passes down over the whole 
thigh, is firmly fixed to the linea aspera, to the condyles 
of the femur, and to the patella, and is continued over 
the knee, to be attached to the heads of the tibia and 
fibula, after which it forms the fascia of the leg. 

On the upper and anterior part of the thigh, below 
Poupart's ligament, there is a slight hollow, where the 
great vessels descend under the crural arch. The fascia 
lata forms, just on the outside and upper part of this, a 
crescent-shaped fold, called its semilunar edge, which is 
strongly connected to the crural arch and linea innomi- 
nata. The commencement of this semilunar edge, some- 
times called the Superior Cornu, is Hey's Ligament. 
The fascia on the outside of the saphenous opening is 
called the Sartorial, that on the inside the Pectineal. 
If the cribriform fascia be removed from between the 
two, we will see the femoral bloodvessels lying beneath 
inclosed in their sheath. Press the finger down from the 
inside of the abdomen on the pubic side of the iliac vein, 
and it will be found to project in the thigh on the inner 
side of the femoral vein, but within its sheath. This 
space is the crural ring, and gives you the course of a 
femoral hernia, which projects forwards, after passing 
under Poupart's ligament through the saphenous opening, 
covered, as you may perceive, by the peritoneum, septum 
crurale, fascia propria, or sheath of the vessels, cribriform 
fascia, superficial fascia, and skin. 

The fascia should now be dissected back ; and, in lift- 
ing up the thicker part of it, which covers the outside of 
the thigh, observe that it is composed of two lamina? of 
fibres. The fibres of the outer lamina run in circles 
round the thigh, while those on the inside, which are 
stronger and more firmly connected, run longitudinally. 



180 



PRACTICAL ANATOMY. 

Fig. 56. 




The Femoral or Crural Arch, and the Structures situated between 
it and the Anterior Part op the Superior Margin of the Pelvis. 

1. The Crural Arch, or Poupart's Ligament, 

2. Pubic Bone. 

3. Superior Anterior Spine of the Ilium. 

4. Spine of the Pubis. 

5. Pectineal Line, and the Insertion of Gimbernat's Ligament. 

7. Iliac Muscle cut. 

8. Crural Nerve cut. 

9. Great Psoas Muscle cut. 

10. Point at which the Crural Branch of the Genito-Crural Nerve 

reaches the Thigh. 

11. Femoral Artery. 

12. Femoral Vein, receiving the Saphena Vein. 

13. External Portion of the Sheath of the Femoral Vessels lying in 

contact with the Femoral Artery. 

14. The large funnel-shaped Cavity of the Sheath on the Inner Side 

of the Femoral Vein. 

15. Internal Femoral Ring, bounded above by the Crural Arch, behind 

by the Pubis, externally by the Vein, and internally by the free 
edge of (16) Grimbernat's Ligament. 



MUSCLES SITUATED ON THE FOREPART AND INSIDE OF 
THE THIGH. 

These are nine in number. 

1. The Tensor Vagina Femoris — Arises, by a narrow, 
tendinous, and fleshy origin, from the external part of the 
anterior superior spinous process of the os ileum ; it forms 
a considerable fleshy belly. » 



RECTUS FEMORIS. 181 

Inserted into the inner side of the great fascia, where it 
covers the outside of the thigh, and a little below the tro- 
chanter major. 

Use: To stretch the great fascia of the thigh, and assist 
in its abduction. 

2. The Sartorius — Arises, by short tendinous fibres, 
from the anterior superior spinous process of the os 
ileum, soon becomes fleshy, extends obliquely across the 
thigh, and passes behind the inner condyle. 

Inserted, by a broad and thin tendon, into the inner side 
of the tibia, immediately below its anterior tubercle. 

Situation : It lies before the muscles of the thigh, cross- 
ing them like a strap about two inches in breadth. At 
the lower part of the thigh, it runs between the tendon of 
the triceps adductor magnus, and that of the gracilis. It 
is inserted above tendons of the gracilis and semitendi- 
nosus, over which it sends an aponeurotic expansion. 

Use: To bend the leg obliquely inwards on the thigh, 
and to bend the thigh forwards. 

It crosses over the femoral artery. 

3. The Eectus Femoris — Arises, by a strong tendon, 
from the inferior anterior spinous process of the os ileum; 
and, by another strong tendon, from the dorsum of that 
bone a little above the acetabulum, and from the capsular 
ligament of the hip-joint. The two tendons soon unite, 
and send off a large belly, which runs down over the 
anterior part of the thigh, and terminates in a flat strong 
tendon, which is 

Inserted into the upper extremity of the patella. 

Situation: To expose the tendinous origins of this 
muscle, the origins of the sartorius and tensor vaginae 
femoris must be raised. Its insertion lies betwixt the 
two vasti. 

Use : To extend the leg on the thigh, and to bend the 
thigh on the pelvis ; to bring the pelvis and thigh for- 
wards to the leg. 

Under the rectus, and partly covered by it, there is a 

large mass of flesh, which, at first sight, appears to form 

but one muscle. It may, however, be divided into three ; 

the separation on the external surface is not generally 

16 



182 



PRACTICAL ANATOMY. 



very evident, but, by following the course of the vessels 
which enter this mass, and by cutting through perhaps a 
few fibres externally, you will discover the line of sepa- 
ration ; and this separation, as yon proceed deeper with 
your dissection, will become very distinct. The three 



Fig. 57. 
A View of the Muscles on the Front of the Thigh. 




1. Tensor Vaginae Fenioris. 

2. Pectineus. 

3. Rectus Fenioris. 

4. Vastus Externus. 

5. Vastus Internus. 

6. Sartorius. 

7. Adductor Longus. 



muscles are named vastus externus, vastus internus, and 
crurasus : at the upper and middle parts of the thigh, 
they may be separated very distinctly ; but for two or 



CRUR^US, OR CRURA LIS. 183 

three inches above the condyles they are connected in- 
separably. 

4. The Vastus Externus — Arises, tendinous and fleshy, 
from the anterior surface of the root of the trochanter 
major, from the outer edge of the linea aspera, its whole 
length, from the oblique line running to the external 
condyle, and from the whole external flat surface of the 
thigh bone. The fleshy fibres run obliquely forwards. 

Inserted into the external surface of the tendon of the 
rectus cruris, and into the side of the patella. 

Situation : This muscle forms the large mass of flesh 
on the outside of the thigh. 

Use : To extend the leg, or to bring the thigh forwards 
upon the leg. 

5. The Vastus Internus — Arises, tendinous and fleshy, 
from the forepart of the root of the trochanter minor, 
from all the upper edge of the linea aspera, from the ob- 
lique line running to the inner condyle, and from the 
whole internal surface of the thigh bone. Its fibres de- 
scend obliquely downwards and forwards. 

Inserted into the lateral surface of the tendon of the 
rectus cruris, and into the side of the patella. 

Situation: This muscle embraces the inside of the 
femur in the same manner as the last described muscle 
does the outside, but it is much smaller ; — it is also in 
part covered by the rectus. At its upper part the sarto- 
rius passes over it obliquely. 

Use: Same as the last. 

6. The Crurjeus, or Cruralis — Arises, fleshy, from 
between the two trochanters of the os femoris, from all 
the forepart of the bone, and from the outside as far 
back as the linea aspera; but from the inside of the bone 
it does not arise, for between the forepart of the femur 
and the inner edge of the linea aspera, there is a smooth 
plain surface, of the breadth of an inch, extending nearly 
the whole length of the bone, from which no muscular 
fibres arise. 

Inserted into the posterior surface of the tendon of the 
rectus, and upper edge of the patella. 



184 PRACTICAL ANATOMY. 

Situation: The principal part of this muscle is lapped 
over, and concealed, by the bellies of the two vasti. 
Use: Same as the last. 

7. The Gracilis arises, by a broad thin tendon, from 
the lower half of that part of the os pubis which forms 
the symphysis, and from the inner edge of the descending 
ramus: — It soons grow fleshy, and forms a belly, which, 
becoming narrower as it descends, terminates in a tendon, 
which passes behind the inner condyle of the thigh-bone, 
and is reflected forwards, to be 

Inserted in the inside of the tibia. 

Situation : From the pubis to the knee it runs immedi- 
ately under the integuments on the inside of the thigh ; it 
is inserted below the tendon of the sartorius, and above 
that of the semitendinosus. 

Use: To bring the thigh inwards and forwards, and to 
assist in bending the leg. 

8. The Pectinalis — Arises, fleshy, from that ridge of 
the os pubis which forms the brim of the pelvis, and 
from the concave surface below the ridge : It forms a 
thick fat belly, 

Inserted, by a flat tendon into the linea aspera, immedi- 
ately below the lesser trochanter. 

Situation: Its origin lies on the inside of the belly of 
the psoas magnus, where that muscle slides over the brim 
of the pelvis, and on the outside of the origin of the ad- 
ductor longus. 

Use: To bend the thigh forwards, to move it inwards, 
and to perform rotation, by turning the toes outwards. 

9. The Triceps Adductor Femoris consists of three 
distinct muscles, which, passing from the pelvis to the 
thigh, lie in different layers upon one another, and have 
nearly the same action. 

(1.) The Adductor Longus — Arises, by a short strong 
tendon, from the upper and inner part of the os pubis, 
near its symphysis; — forms a large triangular belly, 
which, as it descends, becomes broader, bat less thick. 

Inserted, tendinous, into the middle part of the linea 
aspera: from its tendon and that of the vastus internus, 
a membranous canal is formed for the femoral artery. 



ADDUCTOR BREVIS. 



185 



The Anastomotic^ Magna Artery is given off here 
also. 



Fig 58. 
Another View op the Adductor Muscles with thr Pectineus. 



1. Upper Part of Adductor Magnus. 

2. Pectineus. 

3. Adductor Longus. 

4. Adductor Magnus. 

5, 6. Foramina for the first and Second Per- 
forating Arteries. 
7, 8. Foramina for the Femoro-Popliteal ves- 




Situation : It arises betwixt the peetinalis and gracilis, 
and above the adductor brevis. 

(2.) The Adductor Brevis — Arises, fleshy and tendi- 
nous, from the os pubis, between the lower part of the 
symphysis pubis, and the foramen thyroideum : — it forms 
a fleshy belly. 

Inserted, tendinous, into the upper third of the linea 
aspera. 

Situation: Its origin lies under the origins of the peeti- 
nalis and adductor longus, and on the outside of the 
tendon of the gracilis: — It is inserted behind those 
muscles, but before the adductor magnus. The obturator 

16* 



186 



PRACTICAL ANATOMY 



nerve lies upon it after coming through the obturator 
foramen, with an artery of the same name. 



Fig. 59. 
Adductor Muscles, with the Obturator Externus. 




1. Femur. 

2. Ilium. 

3. Pubis. 

4. Obturator Externus. 

5. Superior Fasciculus of the Ad- 

ductor Magnus. 
6, 7. Adductor Brevis. 

8. Adductor Longus. 
9, 10. Adductor Magnus. 

11. Foramen for the Passage of the 

Perforating Arteries. 

12. Same for Femoro-Popliteal Ves- 

sels. 



(3.) The Adductor Magnus — Arises, principally 
fleshy, from the lower part of the body, and from the 
descending ramus of the os pubis, and from the ascend- 
ing ramus of the ischium, as far as the tuberosity of that 
bone. The fibres run outwards and downwards, having 
various degrees of obliquity. 

Inserted, fleshy, into the whole length of the linea 
aspera, into the oblique ridge above the internal condyle 



ARTERIES. 187 

of the os femoris, and, by a roundish long tendon, into 
the upper part of that condyle. 

Situation: This large muscle arises behind and below 
the two other adductors; it forms a flat partition betwixt 
the muscles on the fore and back parts of the thigh. 

Use: To approximate the thighs to each other; — to 
roll them outwards. 



ARTERIES, VEINS, AND NERVES ON THE FOREPART AND 
INSIDE OF THE THIGH. 

1. Arteries. 

The Femoral Artery may be said to pass along the 
inside of the thigh, where it emerges from under Poupart's 
ligament; it lies cushioned on the fibres of the psoas 
magnus, is called the inguinal artery, and is very nearly 
in the mid space between the angle of the pubis, and the 
anterior superior spine of the ileum, nearer however by 
a finger's breadth to the former; having left the groin, it 
assumes the name of Femoral, and in its course down the 
thigh, runs over the following muscles: — The pectinalis, 
part of the adductor brevis ; the whole of the adductor 
longus, and about an inch of the adductor magnus : it 
then slips betwixt the tendon of the adductor magnus and 
the bone, and, entering the ham, becomes the Popliteal 
artery. There is a strong interlacing of the tendinous 
fibres, forming a deep groove for the artery between the 
adductor longus and vastus internus. The artery is ac- 
companied by the Femoral vein, first inside, and then 
gradually getting behind it. The long saphenous nerves 
and short saphenous nerves accompany the vessels, as 
will presently be seen. It is also invested by a firm 
sheath, which consists of condensed cellular membrane, 
intermixed with some tendinous fibres : — For some inches 
below Poupart's ligament, this artery is on its forepart 
only covered by cellular substance, absorbent glands, and 
the general fascia of the thigh; but, meeting with the 
inclined line of the sartorius, it is, during the rest of its 
course, covered by that muscle. It perforates the tendon 



188 



PRACTICAL ANATOMY. 



of the adductor magnus, at the distance of rather more 
than one-third of the length of the bone from its lower 
extremity. 

Branches of the Femoral Artery. — The A. Pro- 
funda comes off from the femoral artery at the distance 
of two or three inches from Poupart's ligament; it is 
nearly as large as the femoral itself, runs down for some 
little way behind it, and terminates in three or four 

Fig. 60. 
Arteries seen on the Front op the Thigh. 




1, 2. Femoral Artery. 

3. Superficial Epigastric, cut off. 
4, 4. External Pudics, cut off. 
5, 5. Profunda Femoris. 

6. Internal Circumflex. 

7. External Circumflex. 
8, 8. Perforating Arteries. 

9. Epigastric. 

10. Circumflexa Ilii. 

11. Muscular branch. 

12. Superior Internal Articular artery. 

13. One of its Branches. The Pop- 

liteal artery begins where the 
femoral terminates, at 2. 



branches, which, perforating the triceps adductor, are 
named Arterl-e Perforantes. These supply the great 
mass of muscles on the back part of the thigh, and inos- 
culate largely with the sciatic, gluteal, and obturator 



VEINS.— NERVES. 189 

arteries. The profunda also sends off two considerable 
branches (the first ones), which, encircling the upper part 
of the thigh, are named Circumflexa Interna, and 

ClRCUMFLEXA EXTERNA. 

The small branches of the femoral artery before the 
profunda may be enumerated as follows: 1. Some twigs 
to the inguinal glands (inguinal); 2. Some to the external 
parts of generation, named Pudicas Externas ; 3. One or 
two going towards the anterior superior spinous process 
of the ileum (Superficial Circumflex Jlii); 4. One 
upwards over the fascia of the abdomen, Superficial 
Epigastric, or arteria ad cutem abdominis. 

The Obturator Artery, arteria obturatrix, which is 
a branch of the internal iliac artery, passes through the 
notch at the upper part of the foramen thyroideum, and 
ramifies on the deep-seated muscles at the upper and 
inner part of the thigh. 

2. Veins. 

The Femoral Vein adheres closely to the femoral 
artery in its passage out of the abdomen, and accompa- 
nies it in its course down the thigh, where it passes under 
Poupart's ligament; it lies on the inside of the artery, 
but, as it descends, it turns more and more posteriorly, so 
that where they perforate the tendon of the adductor 
magnus, the vein is situated fairly behind the artery. 

Its branches correspond to those of the femoral artery ; 
but about an inch below Poupart's ligament, it receives 
the vena saphena major, to which there is no correspond- 
ing artery. 

The Obturator Yein accompanies the obturator 
artery, and has the same distribution. 

3. Nerves. 

Femoral nerve, Nervus Cruralis Anterior, or the 
Anterior Crural nerve, where it passes from under Pou- 
part's ligament, lies about half an inch on the outside of the 
femoral artery; it immediately divides into a number of 
branches, which supply the muscles and integuments on 



190 PRACTICAL ANATOMY. 

the forepart and outside of the thigh: a considerable 
branch, however, accompanies the femoral artery, leaves 
that vessel where it is about to perforate the adductor 
magnus, and appears as a cutaneous nerve on the inside 
of the knee ; proceeding downwards on the inside of the 
leg, it accompanies the saphena vein, and terminates on 
the inner ankle, and upper part of the foot. This branch 
is named Nervus Saphenus Longus. 

Another branch, which, running close to the femoral 
vessels, pierces the fascia, and is distributed below the 
knee. The Short Saphenous. 

Nervus Obturator, or the obturator nerve, is found 
accompanying the obturator artery and vein ; it has the 
same distribution, and some branches extend as far as the 
internal condyle of the thigh-bone, and communicate 
with the nervus saphenus. 

DISSECTION OF THE FOREPART OF THE LEG AND FOOT. 

Carry an incision from the tubercle of the tibia along 
its spine, over the dorsum of the foot to the toes, where 
it may be crossed by a second from the inside to the out- 
side of the foot. Reflect the integuments. The skin 
must be dissected off the toes separately. The fascia 
covering the muscles on the front of the leg is very strong 
It is fixed to the heads of the tibia and iibula,is strength- 
ened by a contribution from the Fascia Lata Femoris, and 
by its deep surface gives origin, in part, to the muscles. 
At the ankle it becomes very strong, and adhering to the 
outer and inner malleolus, forms the Annular Ligament 
which binds down the tendons. Before removing this 
fascia, notice the Saphena Interna Yein and Nerve, 
running along the inside of the leg, and over the ankle 
to the foot, and around the external malleolus. The Sa- 
phena externa vein and nerve to the outer part of the 
foot, and over the outer ankle filaments of the peroneal 
cutaneous nerve (from the Peroneal). 

The fascia should then be dissected off, and, in doing 
this, remark that it sends down processes between the 
muscles ; these are named intermuscular ligaments ; they 



EXTENSOR LONGUS DIGITORUM PEDIS. 191 

give origin to the fibres of all the muscles betwixt which 
they pass, connecting them together inseparably, so that 
the dissection has a rough appearance. 

MUSCLES SITUATED ON THE FOREPART AND OUTSIDE OF 
THE LEG. 

These are six in number. 

1. The Tibialis Anticus — Arises, principally fleshy, 
from the exterior surface of the tibia, from its anterior 
angle or spine, and from nearly half of the interosseous 
ligament, and two-thirds of the length of the bone ; also 
from the inner surface of the fascia of the leg, and from 
the intermuscular ligaments. The fleshy fibres descend 
obliquely, and terminate in a strong tendon, which crosses 
from the outside to the forepart of the tibia, passes through 
a distinct ring of the annular ligament near the inner 
ankle, runs over the astragalus and os naviculare, and is 

Inserted into the upper and inner part of the os cunei- 
forme internum, and the base of the metatarsal bone 
supporting the great toe. 

Situation : The belly is quite superficial, lying under 
the fascia of the leg on the outside of the spine of the tibia. 

Use : To draw the foot upwards and inwards ; or, in 
other words, to bend the ankle-joint. 

2. Extensor Longus Digitorum Pedis — Arises, ten- 
dinous and fleshy, from the outer part of the head of the 
tibia ; from the head of the fibula ; from the anterior 
angle of the fibula almost its whole length, and from part 
of the smooth surface between the anterior and internal 
angles ; from a small part of the interosseous ligament ; 
from the fascia and intermuscular ligaments. 

Below the middle of the leg, it splits into four round 
tendons, which pass under the annular ligament, be- 
come flattened, and are 

Inserted into the root of the first phalanx of each of 
the four small toes, and expanded over the upper side of 
the toes as far as the root of the last phalanx. 

Situation : This muscle also runs entirely superficial ; 
it lies between the tibialis anticus and peroneus longus, 



192 PRACTICAL ANATOMY. 

but at the lower part of the leg it is separated from the 
tibialis anticus by the extensor pollicis longus. 

Use: To extend all the joints of the four small toes: 
to bend the ankle-joint. 

3. Peroneus Tertius — Arises, fleshy, from the anterior 
angle of the fibula, and from part of the smooth surface 
between the anterior and internal angles, extending from 
below the middle of the bone downwards to near its 
inferior extremity ; sends its fleshy fibres forwards to a 
tendon, which passes under the annular ligament, in the 
same sheath as the extensor digitorum longus, and is 

Inserted into the base of the metatarsal bone of the 
little toe. 

Situated: The belly is inseparably connected with the 
extensor longus digitorum, and is properly the outer part 
of it. 

Use: To assist in bending the foot. 

4. Extensor Proprius Pollicis Pedis— Arises, tendin- 
ous and fleshy, from part of the smooth surface between 
the anterior and internal angles of the fibula, and from 
the neighboring part of the interosseous ligament, ex- 
tending from some distance below the head of the bone 
to near its inferior extremity ; the fibres pass obliquely 
downwards and forwards into a tendon, which, inclining 
inwards, passes over the forepart of the astragalus and os 
naviculare, to be 

Inserted into the base of the first and of the second 
phalanges of the great toe. 

Situation: The belly is concealed between the tibialis 
anticus and extensor digitorum longus, and cannot be 
seen till those muscles are separated from one another. 

Use : To extend the great toe ; and to bend the ankle. 

The anterior tibial artery and nerve will be seen at the 
upper third of the limb between the extensor communis 
of the toes and the tibialis anticus, at the middle between 
the last and the extensor pollicis, and at the ankle 
between the last and the extensor communis digitorum. 
Branches will be described presently. 

5. The Peroneus Longus — Arises, tendinous and 
fleshy, from the forepart and outside of the head of the 



MUSCLES OF THE LEG AND FOOT. 



193 



Fig. 61. 
A Side View of the Muscles of the Leg an© Foot. 



10. 
11. 

12, 
13. 
14. 



Biceps Flexor Cruris. 

Vastus Externus. 

Gastrocnemius. 

Soleus. 

Tendo Achillis. 

Tibialis Anticus. 

Extensor Longus Digitorum 

Pedis. 
Extensor Proprius Pollicis. 
Peroneus Tertius. 
Peroneus Longus. 
Peroneus Brevis. 
12. Abductor Minimi Digiti. 
Extensor Brevis Digitorum. 
Interosseus Dorsalis. 




^2 10 13 li 12 14 12 fe 



fibula, and from the adjacent part of the tibia, from the 
external angle of the fibula, and from the smooth surface 
between the anterior and external angles as far down as 
one- third of the length of the bone from its lower ex- 
tremity; also from the fascia of the leg and intermuscular 
ligaments. The fibres run obliquely outwards into a 
tendon, which passes behind the outer ankle, through a 
groove in the lower extremity of the fibula; is then 
reflected forwards through a superficial fossa in the out- 
side of the os calcis, passes over a projection, runs in a 
groove in the os cuboides, passes over the muscles in the 
sole of the foot, and is 

Inserted, tendinous, into the outside of the base of the 
17 



194 PRACTICAL ANATOMY. 

metatarsal bone of the great toe, and into the os cunei- 
forme internum. 

Situation: The belly is quite superficial; it lies between 
the outer edge of the extensor longus digitorum and the 
anterior edge of the soleus. The tendon is superficial 
where it crosses the outside of the os calcis, but, in the 
sole of the foot, is concealed by the muscles situated 
there, and will be seen in the dissection of that part. 

Use: To extend the ankle-joint, turning the sole of 
the foot outwards. 

6. The Peroneus B re vis — Arises, fleshy, from the 
outer edge of the anterior angle of the fibula, and from 
part of the smooth surface behind that angle ; beginning 
about one third down the bone, and continuing its ad- 
hesion to near the ankle ; from the fascia of the leg, and 
from the intermuscular ligaments. The fibres run ob- 
liquely towards a tendon, which passes through a groove 
of the fibula behind the outer ankle, being there inclosed 
in the same ligament with the tendon of the peroneus 
longus, then through a separate groove on the outside 
of the os calcis, and is 

Inserted into the external part of the base of the meta- 
tarsal bone that sustains the little toe. 

Situation: This muscle arises between the extensor 
longus digitorum and peroneus longus ; its belly is over- 
lapped, and concealed by the belly of the peroneus longus. 

Below, it is separated from the peroneus tertius by that 
projection of the fibula which forms the outer ankle, and 
which is only covered by the common integuments. 

Use: Same as that of the peroneus longus. 

MUSCLES ON THE UPPER PART OF THE FOOT. 

Only one muscle is found in this situation. 

Extensor Brevis Digitorum Pedis — Arises, fleshy 
and tendinous, from the anterior and upper part of the 
os calcis, from the os cuboides, and from the astragalus ; 
forms a fleshy belly, divisible into four portions ; these 
send off four slender tendons, which are 

Inserted, the first tendon, into the first phalanx of the 



ARTERIES. 195 

great toe, and the other three into all the small toes ex- 
cept the little one, uniting with the tendons of the exten- 
sor digitorum longus, and being attached to the upper 
convex surface of all the phalanges. 

Situation: The belly of this muscle lies under the ten- 
dons of the extensor digitorum longus and peroneus 
brevis. 

Use: To extend the toes. 



OF THE VESSELS AND NERVES IN THE FOREPART OF THE 
LEG AND FOOT. 

1. Arteries. 

Arteria Tibialis Antica. — The anterior tibial artery- 
passes from the ham betwixt the inferior edge of the pop- 
liteus and the superior fibres of the soleus, and then 
through a large perforation in the interosseous ligament, 
to reach the forepart of the leg ; this perforation is much 
larger than the size of the artery, and is filled up by the 
fibres of the musculus tibialis posticus, which may thus 
be said to arise from the forepart of the tibia. The artery 
then runs down close upon the middle of the interosseous 
ligament, between the tibialis anticus and extensor pro- 
prius pollicis ; below the middle of the leg it leaves the 
interosseous ligament, and passes gradually more for- 
wards ; it crosses under the tendon of the extensor pro- 
prius pollicis, and is then situated between that tendon 
and the first tendon of the extensor longus digitorum. 
At the ankle it runs over the forepart of the tibia, being 
now situated more superficially ; then over the astragalus 
and os naviculare, and over the junction of the os cunei- 
forme internum and medium, crossing under that tendon 
of the extensor brevis digitorum which goes to the great 
toe. Arriving at the space between the bases of the two 
first metatarsal bones, it plunges into the sole of the foot, 
and immediately joins the plantar arch. 

Branches. — 1. A. Eecurrens, which ramifies over the 
forepart of the knee, inosculating with the articular ar- 
teries. 



196 



PRACTICAL ANATOMY. 



2. Numerous twigs to the tibialis anticus, extensor pol- 
licis, and other muscles on the forepart of the leg. 

3. A. Malleolaris Interna ramifies over the inner 
ankle, and inosculates with the perineal and posterior 
tibial arteries. 

4. The External Malleolar ramifies over the outer 
ankle. 

Fig. 62. 
A View of the Anterior Tibial Artery. 



1. Tendon of the Rectus Muscle. 

2. Ligament of the Patella. 

3. Tibia. 

4. Extensor Proprius Pollicis Pedis. 

5. Extensor Communis Digitorum Pedis. 

6. Peroneus Longus and Brevis Muscles. 

7. Inner Border of the Gastrocnemius and So- 

leus Muscles. 

8. Anterior Annular Ligament. 

9. Anterior Tibial Artery. 

10. Recurrent Articular Branch. 

11. Internal Malleolar Branch. 

12. Anterior Peroneal Artery. 

13. Dorsal Artery of the Great Toe. 

14. Tarsal and Metatarsal Branches. 

15. Branch to the Great Toe. 

16. Terminal Branch to join the Plantar Arch. 

17. External Malleolar Artery. 



5. The Tarsal and Metatarsal Arteries are two 
small branches which cross the tarsal and metatarsal 
bones, and pass obliquely to the outer edge of the foot. 



POSTERIOR PART OF THE THIGH. 197 

From the tarsal or metatarsal artery come off the In- 
terosseal Arteries, which supply the interosseal 
spaces and the back part of the toes. 

6. A large branch comes off from the anterior tibial, 
where it is about to plunge into the sole of the foot ; it 
runs along the space betwixt the two first metatarsal 
bones and at the anterior extremity of those bones bi- 
furcates into — 

(1.) A. Dorsalis Hallucis, a considerable branch, 
which runs on the back part of the great toe. 

(2.) A branch which runs on the inner edge of the toe 
next to the great one. 

2. Veins. 

The Anterior Tibial Vein consists of two branches, 
which accompany the artery and its ramifications. 

3. Nerves. 

The Anterior Tibial Nerve is a branch of the pe- 
roneal nerve ; it is seen in the ham arising from the pero- 
neal and crossing under the muscles on the outside of the 
fibula ; it emerges from under the extensor longus digit- 
orum, comes in contact with the anterior tibial artery, 
and accompanies it down the leg; it is distributed on the 
back part of the foot and toes. 

POSTERIOR PART OF THE THIGH. 

Above that part of the fascia which invests the thigh 
behind there are several cutaneous nerves. They 
originate either from the lumbar nerves and come over 
the spine of the ileum, or from the great sciatic nerve 
emerging under the edge of the gluteus maximus. Other 
twigs come from the sacral nerves or the sciatic as it passes 
down the thigh. 

Muscles on the hack part of the thigh. 

There are eleven. Carry an incision along the crest 
of the ileum to the spine, thence over the sacrum to the 
point of the os coccygis. Eeflect the integuments. 

IT* 



198 PRACTICAL ANATOMY. 

Gluteus Maximus — Is usually covered by a large 
amount of adipose substance. It arises, fleshy, from the 
posterior third of the crest of the ileum, from the whole 
lateral surface of the sacrum below the posterior spinous 
process, from the back part of the inferior sacro-sciatic 
ligament, over which the muscle projects, and from the 
side of the os coccygis. The fibres converge to form a 
strong flat tendon, which glides over the trochanter major, 
is connected to the fascia lata, and is 

Inserted into the rough surface on the outer part of the 
linea aspera immeditaely below the trochanter. 

Situation: It is quite superficial, covering all the other 
muscles which are situated on the back part of the hip, 
covering also the tuber ischii, and the tendons of the 
muscles which arise from that projection. Its insertion 
lies between the vastus externus and the adductor magnus 
femoris. 

Use: To restore the thigh, after it has been bent; to 
rotate it outwards ; to extend the pelvis on the thigh, and 
maintain it in that position in the erect posture of the 
body. 

The muscle is now to be lifted from its origin, and left 
hanging by its tendon ; remark the large bursa mucosa 
formed between the tendon and the trochanter major. 

2. The Gluteus Medius — Arises, fleshy, from all the 
outer edge of the spine of the os ileum, as far as the 
posterior tuberosity; from the dorsum of the bone, 
between the spine, and semicircular ridge ; also from the 
rough surface which extends from the anterior superior 
to the anterior inferior spinous process, and from the 
inside of a fascia which covers its anterior part. The 
fibres converge into a strong and broad tendon, which is 

Inserted into the upper and outer part of the great 
trochanter. 

Situation: The posterior part of the belly and the 
tendon are concealed by the gluteus maximus, but the 
anterior and largest part of this muscle is superficial, 
being covered by a strong fascia. 

Use : To draw the thigh bone outwards, or away from 
the opposite limb ; to maintain the pelvis in a state of 



PYKIFOKMIS. 199 

equilibrium on the thigh in progression, while the other 
foot is raised from the ground ; by its posterior fibres to 
rotate the limb outwards ; and by its anterior inwards. 

Having lifted up this muscle from its origin, you will 
discover 

Fig. 63. 




A View of the Gluteus Minimus Muscle. 

3. The Gluteus Minimus. — It arises, fleshy, from the 
semicircular ridge of the ileum, and from the dorsum of 
the bone below the ridge within half an inch of the 
acetabulum. Its fibres run in a radial direction towards 
a strong tendon, which is 

Inserted into the anterior and superior part of the great 
trochanter. 

Situation: It is entirely concealed by the gluteus medius. 
Use : Same as that of the preceding. 

4. The Pykifokmis — Arises, within the pelvis, by three 
tendinous and fleshy origins, from the second, third, and 
fourth false vertebra?, or divisions of the sacrum. It forms 
a thick belly, which passes out of the pelvis through the 
great sacro-ischiatic foramen above the superior sacro- 
sciatic ligament. 



200 PRACTICAL ANATOMY. 

Inserted, by a roundish tendon, into the uppermost part 
of the cavity of the root of the trochanter major. 

Situation: Like the other small muscles of the hip, it 
is entirely concealed by the gluteus maximus; its belly 
lies behind and below the gluteus medius. 

Use : To move the thigh a little upwards, and roll it 
outwards. The great sciatic nerve, the ischiatic and 
internal pudic bloodvessels and nerves, pass out of the 
pelvis below this muscle, and the gluteal bloodvessels and 
nerve above it. 

5. The Gemini consist of two heads, which are distinct 
muscles. 

(1.) The superior arises from the back part of the 
spinous process of the ischium. 

(2.) The inferior from the upper part of the tuberosity 
of the os ischium, and the anterior surface of the posterior 
sacro-sciatic ligament. 

Inserted, tendinous and fleshy, into the cavity at the 
root of the trochanter major, immediately below the 
insertion of the pyriformis, and above the insertion of the 
obturator externus. 

Situation : Like the other muscles, they are covered by 
the gluteus maximus; they lie below the pyriformis, and 
above the quadratus femoris. 

Use: To roll the thigh outwards, and to bind down 
the tendon of the obturator internus. 

Lying between the bellies of the gemini, you will 
perceive, 

6. The Obturator Internus. — It arises, tendinous and 
fleshy, from more than one half of the internal circum- 
ference of the foramen thyroideum, and from the inner 
surface of the ligament which fills up that hole; it forms 
a flattened tendon, which passes out of the pelvis in a 
sinuosity betwixt the spinous process and tuberosity of 
the ischium, and, becoming rounder, is 

Inserted, into the pit at the root of the trochanter 
major. 

Situation : Its origin lies within the pelvis, and cannot 
be exposed till the contents of that cavity are removed ; 
the tendon, where it passes through the notch in the 



QUADRATUS FEMOPJS. 



201 



ischium, is seen projecting between the two origins of 
the gemelli. There is a bursa mucosa betwixt the tendon 

Fig. 64. 
A View of the Muscles on the Back of the Hip. 



1, 2. Gluteus Medius. 

3. Cut Origin of Gluteus 

Maximus. 

4. Piriformis. 
6, 8, 10. Gemelli. 

6, 7. Obturator Internus. 
2. Quadratus Femoris. 




of this muscle and the surface of the ischium over which 
it glides. 

Use: To roll the os femoris obliquely outwards. 

7. The Quadratus Femoris — Arises, tendinous and 
fleshy, from an oblique ridge, which descends from the 
inferior edge of the acetabulum along the body of the 
ischium, between its tuberosity and the foramen thyroid- 
eum ; its fibres run transversely, to be 

Inserted, fleshy, into a rough ridge on the back part of 
the femur, extending from the root of the greater tro- 
chanter to the root of the lesser. 

Situation: It is concealed by the gluteus maximus; its 
origin is in contact with the origin of the hamstring 
muscles. 

Use : To roll the thigh outwards. 



202 PRACTICAL ANATOMY. 

On lifting up the quadratus femoris from its origin, 
and leaving it suspended by its insertion, you discover, 
running in the same direction, the strong tendon of, 

8. The Obturator Externus. — This muscle arises, 
flesby, from almost the whole circumference of the fora- 
men thyroideum, and from the external surface of the 
obturator ligament ; its fibres pass outwards through the 
notch placed between the inferior margin of the aceta- 
bulum and the tuberosity of the ischium, wind around 
the cervix of the os femoris, adhering to the capsular 
ligament, and terminate in a strong tendon, which is 

Inserted into the lowermost part of the cavity, at the 
root of the trochanter major, immediately below the in- 
sertion of the inferior head of the gemini. 

Situation: This muscle cannot be distinctly seen, until 
all the muscles which run from the pelvis to the upper 
part of the thigh are removed, both on the fore and back 
part. 

Use : To roll the thigh-bone obliquely outwards. 

9. The Biceps Flexor Cruris — Arises by two distinct 
heads ; the first, called the Long Head, arises in com- 
mon with the semitendinosus, by a short tendon, from 
the outer part of the tuberosity of the ischium, and, de- 
scending, forms a thick fleshy belly. — The second, termed 
the Short Head, arises, tendinous and fleshy, from the 
linea aspera, immediately below the insertion of the 
gluteus maximus ; aad from the oblique ridge running 
to the outer condyle, where it is connected with the fibres 
of the vastus extern us. The two heads unite at an acute 
angle, a little above the external condyle, and terminate 
in a strong tendon, which is 

Inserted into a rough surface on the outside of the head 
of the fibula. 

Situation : The long head of this muscle is concealed at 
its upper part by the inferior fibres of the gluteus maxi- 
mus ; below this, it is situated quite superficial, — it forms 
the outer hamstring. 

Use: To bend the leg, and particularly by means of 
its shorter head to twist the leg outwards in the bent state 
of the knee. 



SEMITENDINOSUS. 



203 



10. The Semitendinous — Arises, tendinous, in com- 
mon with the long head of the biceps, from the tuberosity 
of the ischium; it has also some fleshy fibres arising from 
that projection more outwardly : — as it descends, it arises, 
for two or three inches, fleshy, from the inside of the 
tendon of the biceps ; forms a thick belly, and terminates 

Fig. 65. 
A View of the Principal Muscles of the Back of the Thigh. 



1. Gluteus Medius. 

2. Gluteus Maximus. 

3. Biceps Flexor Cruris. 

4. Tendon of Semi-tendinosus. 

5. Senii-membranosus muscle. 

6. Semi-tendinosus muscle. 




at the distance of three or four inches from the knee in 
a long round tendon, which, becoming flat, passes behind 
the head of the tibia, and is reflected forwards, to be 






204 PRACTICAL ANATOMY. 

Inserted into the anterior angle of that bone, some little 
way below its tubercle. 

Situation: This muscle, as well as the biceps, is covered 
above by the gluteus maximus; its belly lies between 
the biceps flexor and gracilis, and is situated entirely 
superficial. 

Use : To bend the leg backwards, and a little inwards. 

11. The Semimembranosus — Arises, by a strong round 
tendon, from the upper and outer part of the tuberosity 
of the ischium ; the tendon, soon becoming broader, 
sends off obliquely a fleshy belly; this muscle is con 
tinued, fleshy, much lower down than that last described. 
— The fleshy fibres terminate obliquely in another flat 
tendon, which passes behind the inner condyle, sends off 
a thin aponeurotic expansion under the inner head of 
the gastrocnemius, to cover the posterior part of the 
capsule of the knee-joint, and to be affixed to the external 
condyle: the tendon then becoming rounder, is 

Inserted into the inner and back part of the head of the 
tibia. 

Situation: This is a semi-penniform muscle; its origin 
lies anterior to the tendinous origin of the two last 
muscles, and more outwardly, being situated between 
them and the origin of the quadratus femoris. 

Use : To bend the leg backwards. 

The two last described muscles properly form the inner 
hamstring; but some enumerate among the tendons of 
the inner hamstring, the sartorius and gracilis. 



VESSELS AND NERVES ON THE POSTERIOR PART OF THE 

THIGH. 

Arteries. 

1. Arteria G-lutea, or Iliaca Posterior. — This is 
the largest branch of the internal iliac artery ; it passes 
out of the pelvis at the upper part of the sciatic notch. 
On raising the gluteus maximus, and medius, this artery 
is seen coming over the pyriformis, betwixt the superior 
edge of that muscle and the inferior edge of the os ileum. 



NERVES, 205 

The principal trunk passes under the gluteus medius, and 
ramifies on the dorsum of the os ileum ; other large 
branches are also continued to the gluteus maximus, and 
the muscles situated on the back part of the pelvis. 

2. Arteria Sciatica, vel Ischiatica, is another large 
branch of the internal iliac, which comes out from under 
the piriformis, betwixt the lower edge of that muscle and 
the superior sacro-sciatic ligament ; its principal branches 
descend between the trochanter major and tuberosity of 
the ischium ; it sends other twigs round towards the anus 
and perineum. 

Both these arteries inosculate with the other branches 
of the internal and external iliac. 

The Internal Pudic, a branch of the ischiatic, within 
the pelvis, comes out below the pyriformis, and re-enters 
the pelvis through the lesser ischiatic opening, and con- 
tinuing up along the ramus of the ischium and pubes, is 
ultimately distributed to the penis. 

The Veins correspond exactly to the arteries. They 
terminate in the internal iliac vein. 

Nerves. 

Nervus Sciaticus, vel Ischiaticus, or the Great Sci- 
atic Nerve, from the sacral plexus, is seen coming out 
of the pelvis, below the pyriformis. It descends over 
the gemini and quadratus femoris in the hollow betwixt 
the great trochanter and the tuberosity of the ischium — 
runs down the back part of the thigh, anterior to, i. e, 
nearer the bone than the hamstring muscles ; being situ- 
ated between the anterior surface of the semi-membrano- 
sus and the posterior surface of the triceps adductor 
longus. After sending off the peroneal nerve, it arrives 
in the ham, and becomes the Popliteal .nerve. In this 
course it gives off several branches to the muscles and 
integuments. It sometimes perforates the belly of the 
pyriformis by distinct trunks, which afterwards unite. 

Gluteal Nerve, derived from the fifth lumbar nerve, 
and accompanying the Gluteal Artery. 

Internal Pudic Nerve, derived from the sacral 
18 



206 PEACTICAL ANATOMY. 

plexus, and follows the course of Internal Pudic Artery 
and its branches. 

Lesser Ischiatic — from the sacral plexus: passes out 
below the pyriformis, and passes down the thigh to the 
ham, where it becomes connected with the external 
saphenous nerve. Its branches are muscular, and cuta- 
neous ; to the gluteus maximus integuments of the hip, 
&c. One branch, the Inferior Pudendal, curves around the 
tuber ischii, and is distributed to the scrotum. 

DISSECTION OF THE HAM AND FASCIA ON THE BACK PAKT 
OF THE THIGH. 

On removing the integuments from the back part of 
the knee-joint and leg, we observe a Fascia, which covers 
the great vessels and muscles. It is evidently continued 
from the great fascia of the thigh, is strengthened by ad- 
hesions to the condyles of the femur, and to the head of 
the fibula, and is prolonged upon the muscles on the back 
of the leg. 

Upon dissecting back that part of the fascia which 
covers the ham, the Geeat Sciatic Nerve appears lying 
between the outer and inner hamstring muscles. This 
nerve, having given off branches about the ham, and to 
the integuments on the back of the leg, divides at some 
distance above the condyles of the femur into two large 
branches. 

1. The Greater Nerve continues its course betwixt the 
heads of the gastrocnemii muscles. In the ham it is 
named the Popliteal Nerve, and where it descends in 
the leg, Posterior Tibial. 

2. The lesser Nerve, which is the external branch, is 
named the Peroneal or Fibular Nerve ; it passes out- 
wards and obliquely downwards, runs between the exter- 
nal head of the gastrocnemius, and the tendon of the 
biceps flexor cruris ; and sinks among the muscles which 
surround the head of the fibula. 

Branches of the Peroneal Nerve. 

(1.) Cutaneous branches are sent off from the peroneal 
nerve at its uppermost part over the gastrocnemius to the 



NERVES. 



207 



Fig. 



A View op the Greater and Lesser Sci- 
atic Nerves in their entire Course 
down the Limb. 



£ 



1. Superior Gluteal Nerve. 

2. Pudic Nerves. 

3. Lesser Sciatic Nerve. 

5. Inferior Pudendal Branch. 

6. Continuation of the Small Sciatic. 

7. Greater Sciatic Nerve. 

8, 9. Popliteal and posterior Tihial 
Nerve. 

10, 12. Short Saphenous Nerve. 

11. Peroneal Communicating Branch. 

13. Peroneal Nerve. 



208 PRACTICAL ANATOMY. 

integuments in the back part of the leg, and outer side of 
the foot. Branches also are distributed about the joint. 

(2.) A large branch, the Anterior Tibial Nerve, 
passes under the flesh of the peroneus longus and extensor 
longus digitorum, where those muscles arise from the 
heads of the fibula and tibia ; and comes in contact with 
the anterior tibial artery, which it accompanies down the 
leg. 

(3.) Another branch passes into the upper extremity 
of the peroneus longus, and is continued in the substance 
of that muscle for some space. It then emerges from 
beneath it, and continues its course under the muscles on 
the forepart and outside of the leg ; it pierces the fascia, 
and, becoming cutaneous, is lost on the ankle and upper 
surface of the foot. (The Peroneal Cutaneous.) 

Below the great sciatic nerve, there is much cellular 
membrane and fat, which being removed, the Great 
Popliteal Vein is exposed. It adheres to the Popli- 
teal Artery, which lies under it close upon the bone. 

Arteria Poplitea is the trunk of the Femoral, which 
assumes that name, after it has perforated the tendon of 
the triceps. It lies between the condyles of the femur, 
close upon the bone, and descends between the heads of 
the gastrocnemius. At the lower edge of the popliteus, 
the popliteal artery divides into the Anterior and Pos- 
terior Tibial Arteries. 

Branches. — 1. Articular Arteries .are four or five 
small twigs, ramifying over the knee-joint and neigh- 
boring muscles, inosculating with one another, and with 
the arteries below the knee. 

2. Two branches are sent to the two heads of the gas- 
trocnemii muscles ; the sural twigs are also given to the 
soleus, plantaris, &c. 

The Popliteal Yein receives branches corresponding 
to those of the artery ; it lies behind the artery in the 
erect posture. 

About two inches above the condyle, it receives the 
Yen A Saphena Minor, which returns the blood from the 
outer side of the foot ; the trunk of this vein lies under 
the fascia on the back of the leg. 



209 



DISSECTION OF THE POSTERIOR PART OF THE LEG. 

The fascia investing the posterior part of the leg is 
much thinner than on the front part. Kemove it and the 
muscles on this aspect of the limb may be exposed. 

They are seven in number. 

1. Gastrocnemius — Arises, by two heads, from the 
upper and back part of the condyles of the os femoris. 
Each head forms a fleshy belly, the fibres of which are 
oblique, passing from a tendinous expansion which covers 
the posterior surface of the muscle to another which 
covers the anterior surface. The internal belly is the 
largest, and they are separated by a triangular interval, 
in which the popliteal bloodvessels and nerves pass to the 
leg. These heads unite a little below the knee, in a mid- 
dle tendinous line, and below the middle of the tibia ends 
in a strong flat tendon which joins that of the soleus. In 
the groove on its surface lies the saphena externa nerve 
and vein. 

Eeflect the two heads of the gastrocnemius from the 
femoral condyles, and you will then expose 

2. The Soleus, or Gastrocnemius Internus — which 
arises by two origins or heads. The first, or External 
Origin, which is by much the largest, arises, principally 
fleshy, from the posterior surface of the head of the fibula, 
and from the external angle of that bone, for two-thirds 
of its length, immediately behind the peroneus longus. 
The second, or internal head, arises, fleshy, from an ob- 
lique ridge on the posterior surface of the tibia, just below 
the popliteus, and from the inner angle of that bone, 
during the middle third of its length. The two heads 
which are separated at first by the posterior tibial artery 
and nerve, unite immediately, form a large belly, which, 
covered by the tendon of the gastrocnemius, is continued, 
fleshy, to within a short distance of the ankle-joint; a 
little above which the tendons of the gastrocnemius and 
soleus unite, and form a strong round tendon, named the 
Tendon Achillis, which slides over the upper and 
posterior part of the os calcis, where it is furnished with 
a small bursa mucosa, to be 

18* 



210 



PRACTICAL ANATOMY. 



Inserted into a rough surface on the back part of that 
bone. 

Situation : The gastrocnemius arises between the ham- 
string tendons: Its belly is superficial, and forms the 
upper or greater calf of the leg. 

The soleus has its largest part concealed by the gastro- 
cnemius, but part of it appears on each side of the belly 
of that muscle. There is a bursa mucosa betwixt the 
upper part of the os calcis and the tendo Achillis. 

Fig. 67. 
The Superficial Muscles of the Posterior Face of the Leg. 



1. The Biceps Muscle forming the Outer Ham- 

string. 

2. The Tendons forming the Inner Hamstring. 

3. The Popliteal Space. 

4. The Gastrocnemius Muscle. 

5. The Soleus. 

6. Tendo Achillis. 

7. The Posterior Tuberosity of the Os Calcis. 

8. The Tendons of the Peroneus Longus and 

Brevis Muscles passing behind the outer 
ankle. 

9. The Tendons of the Tibialis Posticus and 

Flexor Longus Digitorum Pedis passing 
into the foot behind the inner ankle. 



Use: To elevate the os calcis, and thereby, to lift up 
the whole body as a preparatory measure to its being car- 



ried forward in 



to carry the leg backwards 



POPLITEUS. 211 

on the foot when that is fixed; the gastrocnemius, from its 
origin in the thigh, also bends the leg on the thigh. 

The heads of the gastrocnemius should now be lifted 
up, which will expose 

3. The Plantaris. — This muscle arises, fleshy, from 
the upper part of the external condyle, and from the ob- 
lique ridge above that condyle, forms a pyramidal belly 
about three inches in length, which adheres to the cap- 
sule of the knee-joint, runs over the popliteus, and ter- 
minates in a long, slender, thin tendon. This tendon 
passes obliquely inwards over the inner head of the soleus, 
and under the gastrocnemius; emerges from between 
those two muscles, where their tendons unite, and then 
runs down by the inside of the tendo Achillis, to be 

Inserted into the posterior part of the os calcis, on the 
inside of the insertion of the tendo Achillis, and some- 
what before it. 

Situation: The origin and belly of this muscle are 
concealed by the external head of the gastrocnemius. 

Use: To extend the foot and roll it inwards, and to 
assist in bending the leg. 

4. The Popliteus — Arises, within the capsular liga- 
ment of the knee, by a round tendon, from a deep pit or 
hollow on the outer side of the external condyle ; adheres 
to the posterior and outer surface of the external semi- 
lunar cartilage; passes, within the cavity of the joint, 
over the side of the condyle to its back part ; perforates 
the capsular ligament, and forms a fleshy belly, which 
runs obliquely inwards, being covered by a thin tendinous 
fascia, to be 

Inserted, broad, thin, and fleshy, into an oblique ridge 
on the posterior surface of the tibia, a little below its 
head, and into the triangular space above that ridge. 

Situation: This muscle is concealed entirely by the 
gastrocnemius. 

Use: To bend the leg, and, when bent, to roll it, so as 
to turn the toes inwards. 

The belly of the soleus should now be lifted, in order 
to expose the deeply seated muscles. A strong mem- 
branous fascia {Intermuscular) is seen connecting and 
investing them, which is to be removed. This fascia also 



212 PRACTICAL ANATOMY. 

covers the posterior tibial vessels and nerve, but the 
description of the course of these vessels, though seen in 
this stage of the dissection, must be deferred. 

The deep-seated muscles are, 

The Flexor Longus Digitorum Pedis ; situated behind 
the tibia. 

The Flexor Longus Pollicis Pedis, situated behind the 
fibula. 

The Tibialis Posticus, which is almost concealed by 
the two other muscles, and by the fascia, which connects 
them, and binds them down. 

5. The Flexor Longus Digitorum Pedis Perforans 
— Arises, fleshy, from the posterior flattened surface of 
the tibia, between its internal and external angles, below 
the attachment of the soleus, and continues to arise from 
the bone to within two or three inches of the ankle ; the 
fibres pass obliquely into a tendon. This tendon runs 
behind the inner ankle in a groove of the tibia, passes 
under a strong ligament which goes from the inner ankle 
to the os calcis, and having received a strong tendinous 
slip from the flexor pollicis longus, divides about the 
middle of the sole of the foot into four tendons, which 
pass through the slits in the tendon of the flexor digits 
orum brevis, and are 

Inserted into the extremity of the last joint of the four 
lesser toes. 

The situation of the tendon is described with the 
muscles of the foot. 

Use: To bend the last joint of the toes, and to assist 
in extending the foot. 

6. Flexor Longus Pollicis Pedis — Arises, fleshy, 
from the posterior flat surface of the fibula, continuing 
its origin from some distance below the head of the bone 
to within an inch of the ankle. The fleshy fibres termi- 
nate in a tendon, which passes behind the inner ankle 
through a groove in the tibia ; next through a groove in 
the astragalus, crosses in the sole of the foot the tendon 
of the flexor longus digitorum, to which it gives a slip of 
tendon ; passes between the two sesamoid bones, and is 

Inserted into the last joint of the great toe. 

Situation: It lies on the outside of the flexor longus 



TIBIALIS POSTICUS. 



213 



digitorum, between that muscle and the peroneus longus; 
the tendon will be seen in the foot. 

Use: To bend the last joint of the great toe, and, being 
connected by a cross slip to the flexor digitorum com- 
munis, to assist in bending the other toes. 

Fig. 68. 
Deep Muscles on the Back of the Leg. 



9. 
10. 
11. 
12. 
13. 



The Lower Extremity of the Femur. 

Ligament of Winslow. 

Tendon of the Semimembranous Muscle. 

Internal Lateral Ligament of the Knee-Joint. 

External Lateral Ligament. 

Popliteus Muscle. 

Flexor Longus Digitorum Pedis. 

Tibialis Posticus Muscle. 

Flexor Longus Proprius Pollicis Pedis. 

Peroneus Longus Muscle. 

Peroneus Brevis. 

Tendo Achillis divided near its Insertion. 

Tendons of the Tibialis Posticus and Flexor 
Longus Digitorum Pedis, just as they are 
about to pass beneath the Internal Annu- 
lar Ligament. The interval between the 
latter Tendon and the Tendon of the 
Flexor Longus Pollicis is occupied by the 
Posterior Tibial Vessels and Nerve. 



^3 



7. The Tibialis Posticus — Arises, fleshy, from the 
posterior surface of both the tibia and fibula, immediately 
below the upper articulation of these bones with each 
other ; from the whole of the interosseus ligament ; from 
the angles of the bones to which that ligament is attached ; 
and from the flat surface of the fibula behind its internal 
angle for more than two-thirds of its length. The fibre 



214 PRACTICAL ANATOMY. 

run obliquely towards a middle tendon, which, becoming 
round, passes behind the inner ankle through a groove in 
the tibia. 

Inserted into the upper and inner part of the os navicu- 
lare, being farther continued through a groove in that 
bone to the internal and external cjmeiforme bones. 

Situation : The belly is concealed at its lower part by 
the flexor longus digitorum and flexor pollicis, and can- 
not be seen till those muscles are separated. The tendon 
crosses under that of the flexor longus digitorum above 
the ankle, and, where it passes through the groove in the 
tibia, is situated more forward than the tendon of that 
muscle. 

Use : To extend the foot, and turn it inwards. 



VESSELS AND NERVES OF THE POSTERIOR PART OF THE 

LEG. 

1. Arteries. 

Arteria Tibialis Postica. — The posterior tibial 
artery, which is the continued trunk of the popliteal, 
sinks under the origins of the soleus, and runs down the 
leg between that muscle and the more deeply scattered 
flexors of the toes: It does not lie in immediate contact 
with the fibres of the flexors, but, like the femoral artery, 
is invested by a strong sheath of condensed cellular 
membrane. It is, together with its veins and accom- 
panying nerve, also supported by the fascia which binds 
down the deep-seated muscles. As it descends, it gradu- 
ally advances more forwards, following the course of the 
flexor tendons: it passes behind the inner ankle, lying 
posterior to the tendon of the flexor longus digitorum, 
and anterior to that of the flexor longus pollicis. It 
sinks under the abductor pollicis, arising from the os 
calcis, and immediately divides into two branches : 

(1.) The Internal Plantar Artery is the smallest, and 
ramifies among the mass of muscles situated on the inner 
edge of the sole of the foot. 

(2.) The External Plantar Artery directs its course 



ARTERIES. 



215 



outwards, and having reached the metatarsal bone of the 
little toe, forms the Plantar Arch, which crosses the 
three middle metatarsal bones obliquely, about their 



Fig. 69. 
Arteries on the Back of the Thigh, Leg, and Foot. 



1,2. 
3. 

4. 
5. 
6. 

7. 
8. 
2. 



9. 



10. 
11. 

12. 
13. 
14. 
15. 
16. 



Popliteal Artery. 

Anastomotic Artery, the Last Branch, 
of the Femoral. 

Superior Internal Articular Artery. 

Superior External Articular Artery, 

Inferior Internal Articular. 

Azygos Artery. 

Sural or Gastrocnemial Arteries. 

Point at which the Popliteal divides 
into the Anterior and Posterior Ti- 
bial Arteries. 

Point at which the Posterior Tibial 
gives off the Peroneal Artery ; being 
called thus far the Tibio-Peroneal 
Artery. 

Nutritious Artery of the Tibia. 

Continued Trunk of the Posterior Ti- 
bial Artery. 

Peroneal Artery. 

External Malleolar Artery. 

External Plantar Artery. 

Internal Malleolar Artery. 

Inferior External Articular Artery. 




middle, and terminates at the space betwixt the two first 
metatarsal bones, where the trunk of the anterior tibial 
artery joins the arch. The convexity of this arch is 
towards the toes, and sends off the following branches, 
a, A small branch to the outside of the little toe. 



216 PRACTICAL ANATOMY. 

b, Eamus digitalis primus, or the first digital artery, 
which runs along the space between the two last metatar- 
sal bones, and bifurcates into two branches, one to the 
inner side of the little toe, and the other to the outer side 
of the next toe. 

c, The second digital artery, which runs along the next 
interosseous space, and bifurcates in a similar manner. 

d, The third digital artery. 

e, The fourth, or Great Digital Artery, which sup- 
plies the great toe, and the inner side of the toe next 
to it. 

The concavity of the arch sends off the Interosseal 
arteries, three or four small twigs, which go to the deep- 
seated parts in the sole of the foot, and, Perforating be- 
tween the metatarsal bones, inosculate with the superior 
interosseal arteries on the upper side of the foot. 

The branches of the Posterior Tibial Artery in the 
leg are, 

1. The Peroneal Artery, which comes off from the 
tibial a little after it has sent off the anterior tibial ; it is 
generally of a considerable size ; it runs upon the inside 
of the fibula, giving numerous branches to the peroneal 
muscles and flexor of the great toe; its course is irregular. 
At the lower part of the leg, it splits into, 

a, A. Peronea Anterior, which passes betwixt the 
lower heads of the tibia and fibula, to the forepart of the 
ankle, where it is lost. 

b, A. Peronea Posterior is properly the termination 
of the artery ; it descends along the sinuosity of the os 
calcis, inosculating with the branches of the tibialis 
postica, and terminates in the posterior part of the sole 
of the foot. 

2. Muscular branches arise from the artery as it de- 
scends ; twigs also are sent over the heel and ankle. 

2. Veins. 

Ven^: Tibiales Posticus. — The posterior tibial veins 
are generally two in number ; they accompany the artery, 
and terminate in the popliteal vein ; they are formed of 
branches, which correspond to those of the artery. 



DISSECTION OF THE SOLE OF THE FOOT. 217 

3. Nerves. 

The Posterior Tibial Nerve, which is the continua- 
tion of the great sciatic nerve, sinks below the soleus, 
and accompanies the posterior tibial artery; it gives off 
numerous filaments to the muscles in its neighborhood. 
At first it is immediately behind the artery, gradually 
getting on the outside of it as it descends : so that where 
they pass along the sinuosity of the os calcis, the nerve 
is situated close in contact with the side of the artery, 
but nearer to the projection of the heel than that vessel 
is. With the artery, it divides into, 

1. The internal plantar nerve, and, 

2. The external plantar nerve. — These nerves supply 
the muscles and integuments in the sole of the foot. 

dissection of the sole of the foot. 

The cuticle is very much thickened on the sole of the 
foot from constant pressure; betwixt the integuments 
and plantar aponeurosis, we find a tough granulated fat, 
which adheres firmly to the aponeurosis, and is dissected 
off* with difficulty. 

Aponeurosis, seu Fascia Plantaris, is a very strong 
tendinous expansion, which arises from the projecting 
extremity of the os calcis, and passes to the root of the 
toes, covering and supporting the muscles of the sole of 
the foot. Where it arises from the heel, it is thick, but 
narrow ; as it runs over the foot, it becomes broader and 
thinner ; and it is fixed to the head of each of the meta- 
tarsal bones by a bifurcated extremity, which, by its 
splitting, leaves room for the tendons, &c, to pass. It 
seems divided into three portions, which are connected by 
strong fasciculi of tendinous fibres ; and fibres are sent 
down, forming perpendicular partitions among the muscles, 
and separating them into three classes : — 

1. The middle portion, which is the largest, and under 
which are contained the flexor brevis digitorum, and the 
tendons of the flexor longus and lumbricales. 
19 



218 



PRACTICAL ANATOMY. 



2. The external lateral portion, which covers the 
muscles of the little toe. 

3. The internal lateral portion, concealing the muscles 
of the great toe. 

On removing the plantar aponeurosis, the first order 
of muscles in the sole of the foot is exposed : it consists 
of three muscles: 

1. Abductor Pollicis Pedis — Arises, tendinous and 
fleshy, from the lower and inner part of the os calcis; 
from a ligament which extends from the os calcis to the 
os naviculare ; from the inside of the os naviculare and 
cuneiforme internum ; and from the fascia plantaris. 

Inserted, tendinous, into the internal sesamoid bone and 
base of the first phalanx of the great toe. 

Use: To move the great toe from the rest. 



Fig. 70. 
Muscles of the Side of the Foot. 




1. Abductor Pollicis. 

2, 2. Its Tendon. 

3, 3. Flexor Brevis Pollicis. 

4. Tendon of Flexor Longns Pollicis. 

5. Aponeurosis Plantaris, divided. 
6, 7. Flexor Brevis Digitorum Pedis. 

7. Lumbricales. 

8. Abductor Minimi Digiti. 

9. Flexor Brevis Minimi Digiti. 
10. Interossei. 



2. Abductor Minimi Digiti Pedis— Arises, tendinous 
and fleshy, from the outer side of the os calcis, and from 



MUSCLES OF THE FOOT. 219 

a strong ligament which passes from the os calcis to the 
metatarsal bone of the little toe; also from the fascia 
plantaris. 

Inserted, tendinous, into the base of the metatarsal bone 
of the little toe, and into the outside of the base of the 
first phalanx. 

This muscle can frequently be divided distinctly into 
two portions. 

Use : To move the little toes from the other toes. 

3. Flexor Brevis Digitorum Pedis Perforatum — 
Arises, fleshy, from the anterior and inferior part of the 
protuberance of the os calcis, and from the inner surface 
of the fascia plantaris ; also from the tendinous partitions 
betwixt it and the abductors of the great and little toe. 
It forms a thick fleshy belly, and sends off four tendons, 
which split for the passage of the tendons of the flexor 
longus digitorum, and are 

Inserted into the second phalanx of the four lesser toes. 

The tendon of the little toe is often wanting. 

Use: To bend the second joint of the toes. 

The first order of muscles being removed, or being 
lifted from their origins and left hanging by their tendons, 
the second order is exposed. 

1. The tendon of the flexor longus digitorum pedis is 
seen coming from the inside of the os calcis, and, having 
reached the middle of the foot, dividing into its four ten- 
dons, which pass through the slits of the tendons of the 
flexor digitorum brevis, and are inserted into the base of 
the last phalanx of the four lesser toes. 

2. The tendon of the Flexor longus pollicis is seen 
crossing under the tendon of the flexor longus digitorum, 
and, having given to it a short slip of tendon, proceeding 
between the two sesamoid bones to the base of the last 
phalanx of the great toe. 

3. Flexor Digitorum Accessorius, or Massa Carnea 
Jacobii Sylvii — Arises, fleshy, from the sinuosity at the 
inside of the os calcis, and, tendinous, from that bone 
more outwardly. It forms a belly of a square form. 

Inserted into the outside of the tendon of the flexor 
digitorum longus, just at its division. 



220 PEACTICAL ANATOMY. 

Use: To assist the flexor longus. 

4. Lumbeicales Pedis — Arises, by four tendinous and 
fleshy beginnings, from the tendons of the flexor longus 
digitorum, immediately after their division. 

Inserted, by four slender tendons, into the inside of the 
first phalanx of the four ]esser toes, and into the tendi- 
nous expansion that is sent from the extensors to cover 
the upper part of the toes. 

Use : To promote the flexion of the toes, and to draw 
them inwards. 

The second order of muscles being removed, we expose 
the third order : — 

1. Flexor Brevis Pollicis Pedis. — It arises, tendi- 
nous, from the under and forepart of the os calcis, where 
it joins with the os cuboides ; also from the os cunei- 
forme externum. It forms a fleshy belly, which is con- 
nected inseparably to the abductor and adductor pollicis. 

Inserted, by two tendons, into the external and internal 
sesamoid bones ; and it is continued on into the base of 
the first phalanx of the great toe. 

Use: To bend the first joint of the great toe. 

2. Adductor Pollicis Pedis — Arises, tendinous and 
fleshy, from a strong ligament which extends from the 
os calcis to the os cuboides, and from the roots of the 
second, third, and fourth metatarsal bones. It forms a 
fleshy belly, which seems at its beginning divided into 
two portions. 

Inserted, tendinous, into the external sesamoid bone and 
root of the metatarsal bone of the great toe. 
Use: To bring this toe nearer the rest. 

3. Flexor Brevis Minimi Digiti Pedis — Arises, ten- 
dinous and fleshy, from the os cuboides, and from the 
root of the metatarsal bone of the little toe. 

Inserted, tendinous, into the base of the first phalanx 
of the little toe and into the anterior extremity of the 
metatarsal bone. 

Use: To bend this toe. 

4. Transversalis Pedis — Arises, tendinous, from the 
anterior extremity of the metatarsal bone supporting the 



MUSCLES OF THE FOOT. 



221 



Fig. 71. 
Dissection of a SecoND Layer of the Plantar Muscles of the Foot. 



1. Tendon of Tibialis Posticus. 

2. Tendon of Flexor Longus Pollicis. 

3. Tendon of Flexor Longus Digitorum. 

4. Point where it separates into four Ten- 

dons. 

5. Points of Insertion. 

6. Flexor Accessorius. 

7. Calcaneo-cuboid Ligament. 

8. Lumbricales Pedis. 

9. Adductor Pollicis. 

10. Flexor Brevis Pollicis. 

11. Tendon of Peroneus Longus. 

12. Flexor Brevis Minimi Digiti. 

13. Interossei Muscles. 




little toe ; becoming fleshy, it crosses over the anterior 
extremities of the other metatarsal bones. 

Inserted, tendinous, into the anterior extremity of the 
metatarsal bone of the great toe, and into the internal 
sesamoid bone adhering to the adductor pollicis. 

Use: To contract the foot, by bringing the toes nearer 
each other. 

Banging with this order of muscles, we may also 
observe — 

A broad strong ligament, passing from the anterior 
sinuosity of the os calcis over the surface of the os cu- 
boides. 

The tendon of the tibialis posticus, dividing into nume- 
rous tendinous slips, to be inserted into the bones of the 
tarsus. 

Having removed the muscles last described, we expose 
the fourth and last order. 

The tendon of the peroneus longus is seen passing 
19* 



222 



PKACTICAL ANATOMY. 



along a groove in the os cuboides, and crossing the tarsal 
bones, to be inserted into the base of the metatarsal bone 
of the great toe, and into the internal cuneiforme and 
second metatarsal bones. 

Fig. 72. 
Plantar Interossei. 



1. Metatarsal Bone of the Great Toe. 

2, 2, 2. Interosseous Muscles. 

3, 3, 3. Their Insertion into the First Phalanx. 



Interossei Pedis Inteeni are three in number, situ- 
ated in the sole of the foot. They arise, tendinous and 

Fig. 73. 
Dorsal Interossei Muscles. 





1. First Metatarsal Bone. 
2, 2. Interossei Muscles. 
3, 3, 3, 3. Their tendinous inser- 
tion into the first Pha- 
langes of the Toes. 



MALE ORGANS OF GENERATION. 223 

fleshy, from between the metatarsal bones of the four 
lesser toes, and are 

Inserted, tendinous, into the inside of the base of the 
first phalanx of each of the three lesser toes. 

Use : To move the three lesser toes inwards towards 
the great toe. 

Interossei Pedis Externi are four in number, larger 
than the internal interossei, and situated on the back of 
the foot ; they are bicipites, or arise by two slips. 

Arise, tendinous and fleshy, between the metatarsal 
bones of all the toes. 

Inserted, the first, abductor indicis pedis, into the inside 
of the base of the first phalanx of the fore-toe; — the second, 
adductor indicis pedis, into the outside of the same toe ; 
— the third, adductor medii digiti pedis, into the outside 
of the middle toe ; the fourth, adductor tertii digiti pedis, 
into the outside of the third toe. 

Use : To separate the toes. 



CHAPTER XIII. 

DISSECTION OF THE PERINEUM AND OF THE MALE 
ORGANS OF GENERATION. 

The subject should be secured as in the operation for 
Stone. A staff passed into the bladder, and some hair into 
the rectum. Carry two incisions, one upon either side, 
from the root of the scrotum to the tuberosities of the 
ischii ; from thence to the point of the coccj^x, and dissect 
the flap upwards. 

The muscles of the perineum consist of five pair, and 
a single muscle : 
Erector Penis, *} 

Accelerator TJrin^), , , a . . A 

Transversa Perinei, \ on .f ch Sphincter Ani, 
Levator Ani, slD §' le mascle - 

COCCYGEUS, 



224 PRACTICAL ANATOMY. 

The Raphe or line running along the skin of the peri- 
neum, marks the place where the opposite muscles meet. 
The appearance of these muscles will vary in different 
subjects. In those who have died weak and emaciated, 
the fibres will be pale, and not very evident, while in 
strong muscular men, who have expired suddenly, they 
will be very distinct. When the fat and superficial fascia 
have been carefully cleared away, the first muscle com- 
ing into view will be the superficial sphincter ani ; and 
in front of the anus, a shining fascia will be seen stretch- 
ing across from the ramus of the pubes and ischium of one 
side to the same points on the other. This is the Super- 
ficial Perineal Fascia of some. The Middle Peri- 
neal fascia of others. All in front of the anus is called 
the anterior or urethral perineum. This fascia covers the 
muscles of this part of the perineum, and, instead of con- 
tinuing back over the superficial sphincter ani, dips down 
in front of the anus, and becomes connected with the 
anterior layer of the triangular ligament, or Deep Peri- 
neal fascia. On either side of the rectum, and the tuber- 
osities of the ischii, are two large deep fossae, filled with 
granulated fat, and having bloodvessels and nerves from 
the Internal Pudic Artery, vein, and nerves. These are 
the Ischio-Rectal Foss^:. The outer boundary of these 
cavities is formed by the obturator internus muscles, 
covered by the obturator fascia ; the inner boundary by 
the levator ani muscles, covered by the fascia of the same 
name. Clean off the fascia, and you will expose the fol- 
lowing muscles: — 

1. The Erector Penis — Arises, tendinous and fleshy, 
from the tuberosity of the os ischium ; its fleshy fibres 
proceed upwards over the crus of the penis, adhering to 
the outer and inner edges of the ascending ramus of the 
os ischium, and of the descending ramus of the os pubis ; 
— but before the two crura meet to form the body of the 
penis, it ends in a flat tendon, which is lost in the strong 
tendinous membrane that covers the corpus cavernosum. 

Situation? This muscle covers all the surface of the 
crus penis that is not in contact with bone. 

Use: It was formerly supposed to compress the crus 



ACCELERATORES URIN.E. 



225 



penis, and thereby to propel the blood into the forepart 
of the corpus cavernosum ; and to press the penis upwards 



Fig. 74. 
View of the Deep Perineal Fascia. 
1 




1. Symphysis Pubis. 

2. Sub-pubic Ligament. 

8. Triangular Ligament, or Deep Perineal Fascia. 

4. Perforation for the Urethra. 

5. Two prominences of anterior layer of the Fascia, marking the 

Position of the included Cowper's Glands. 

6. Pudic arteries. 

7. Arteries of the Bulb. 

8, 8, 8. The Superficial Perineal Fascia dissected off in three angular 
Flaps. 

against the pubis. But its obvious effect must be that of 
drawing the crus downwards to the tuber ischii ; which 
cannot have any influence in contributing to the erect 
state of the organ. 

2. Acceleratores URlNiE — Arise from a tendinous 
point in the centre of the perineum, and a tendinous line 
in the middle of the bulb. The fibres diverge. The in- 
ferior ones 



226 



PRACTICAL ANATOMY. 



Inserted into the ramus of the ischium and pubis. The 
middle surround the corpus spongiosum, and the ante- 
rior ones extend upon the corpus cavernosum. 

Use : To drive the urine and semen forwards, b y com- 
pressing the lower part of the urethra, and to propel 
the blood towards the corpus spongiosum and the glans 
penis. 

Fig. 75. 




Pekineal Muscles op the Male. 



1. 


Accelerator Urinse. 


7. Gluteus Maximus. 


2. 


Erector Penis. 


8. Adductor Magnus. 


3. 


Transversus Perinsei. 


9. Gracilis. 


4. 


Sphincter Ani. 


10. Adductor Longus. 


5. 


Levator Ani. 


11, 13. Corpora Cavernosa 


6. 


Coccygeus. 


12. Uretnra. 




14, 14. 


Spermatic Cords. 



3. The Transversus PERiNiEi — Arises from the tuber 
ischii, immediately behind the attachment of the erector 
penis ; thence its fibres run transversely inwards. 

Inserted into the central point of union where the 
spinchter ani touches the accelerator urinae, and where a 
kind of tendinous projection is formed, common to the 
five muscles. 

Use: To dilate the bulb of the urethra, to prevent the 



LEVATOE ANI. 227 

anus from being too much protruded, and to retract it 
when protruded. 

The middle perineal fascia passes behind these muscles 
to join the deep or triangular ligament. Accompanying 
these muscles, is the Transversales Perinei arteries (from 
the superficial perineal arteries), which, coming from the 
internal pudic, pass up in the groove between the erectores 
peni and acceleratores urinae. 

There is sometimes another slip of fibres, the Trans- 
versus Perinei Alter, which has the same course, and 
is inserted into the posterior part of the bulb of the 
urethra. 

4. The Sphincter Ani Externus consists of two 
semicircular planes, which run round the extremity of 
the rectum, passing nearly as far out as the tuber ischii ; 
the fibres of each side decussate where they meet, and 
are 

Inserted into the extremity of the os coccygis behind ; 
and before, into a tendinous point common to this muscle 
and to the acceleratores urinae and transversi perinei. 
This tendinous point is worthy of remark; it seems to 
consist in part of an elastic ligamentous substance. 

Use : To close the anus, or extremity of the rectum, 
and to pull down the bulb of the urethra. It is in a state 
of constant contraction, independently of the will. 

5. Sphincter Ani Internus — a band of fibres under 
the superficial sphincter, surrounding the lower end of 
the rectum. 

More deeply seated than the muscles now described, we 
see some of the fibres of 

The Levator Ani. — This muscle arises from the in- 
side of the os pubis, at the upper edge of the foramen 
thyroideum, from the inside of the os ischium, from the 
tendinous membrane covering the obturator internus and 
coccygeus muscles; from the semicircular origin its fibres 
run down like radii towards a centre, and are 

Inserted in the two last bones of the os coccygis, and 
into the extremity of the rectum, passing within the fibres 
of the sphincter ani, but on the outside of the longitudi- 
nal fibres of the gut itself. 



228 PEACTICAL ANATOMY. 

Situation : This muscle, with its fellow, very much re- 
sembles a funnel, surrounding the extremity of the rec- 
tum, the neck of the bladder (which passes through a 
slit in his fibres), the prostate gland, and part of the vesi- 
culse seminales. 

Use : To draw the rectum upwards after the evacuation 
of the faeces, to assist in shutting it, and to compress the 
vesiculaa seminales and other viscera of the pelvis. 

6. The Coccygeus arises, tendinous and fleshy, from 
the spinous process of the os ischium, and covers the in- 
side of the posterior sacro-sciatic ligament ; it forms a 
thin fleshy belly. 

Inserted into the extremity of the os sacrum, and into 
the lateral surface of the coccygis, immediately before the 
gluteus maximus. 

Situation: It is placed betwixt the levator ani and 
edge of the gluteus maximus. 

Use : To support and move the os coccygis forwards, 
and connect it more firmly with the sacrum. 

If the muscles be cleared away the corpus spongiosum 
will be found to rest upon a dense membrane, which is 
placed beneath the arch of the pubes, and between the 
rami of the pubes and ischii. It is the Triangular 
Ligament. This ligament consists of two layers, between 
which is placed the membranous portion of the urethra, 
the glands of Cowper, and some muscular fasciculi termed 
the muscles of Wilson and Gruthrie. The internal pudic 
artery, with nerve, is likewise between its lamellse, and gives 
off a large branch, the Arteria Bulbosi, and another, 
the Arteria Cavernosi. The main trunk finally be- 
comes the Arteria Dorsalis Penis. 

The rectum must now be separated from the bladder, 
and pulled downwards. This dissection will expose a 
great part of the levator ani ; the neck and body of the 
bladder ; the prostate gland ; the vesiculae seminales ; 
part of the vasa deferentia; part of the ureters; the 
urethra, its bulb, and corpus spongiosum ; the crura penis, 
and their origin from the ischium; observe, 

1. The connection of the bladder and rectum, and the 
cellular substance interposed between them. 



VASA DEFERENTIA. 229 

2. The prostate gland, situated between the bladder and 
rectum, surrounding the beginning of the urethra in such 
a manner that one- third of its thickness is situated above 
the urethra, and two-thirds below it ; its shape is some- 
what pyriform. 

3. The Urethra. — The curve should be carefully 
observed. The urethra begins at the neck of the blad- 
der ; it is a continuation of that part of the bladder which 
in the erect posture is lowest. (1.) Its beginning is em- 
bedded in the prostate gland. (2.) Its membranous part 
is quite narrow ; situated between the prostate gland and 
bulb of the urethra, and between the layers of the trian- 
gular ligament. (3.) The urethra then enters the corpus 
spongiosum. 

4. The Corpus Spongiosum Urethra consists of a 
plexus of minute veins covered externally by a thin but 
uniform fibrous sheet ; it surrounds the urethra from a 
short distance from the bladder to its extremity. At its 
beginning it forms a considerable body of a pyriform 
shape, termed the Bulb of the Urethra; that part of the 
bulb which is below the urethra is named the pendulous 
part of the bulb. The corpus spongiosum has on its an- 
terior the glans penis. 

5. The Glandule Ante prostata, or Cowper's 
Glands, are two small glands of the size of peas between 
the layers of the triangular ligament. 

6. The Vesicul^; Seminales are two soft, whitish, 
knotted bodies, about three or four fingers' breadth in 
length and one in breadth, and about three times as broad 
as thick ; situated between the rectum and lower part of 
the bladder obliquely, so that their inferior extremities 
are contiguous, and are affixed to the base of the prostate 
gland, while their superior extremities are at a distance 
from each other, extending outwards and upwards, and 
terminating just on the inside of the insertion of the ure- 
ters in the bladder. They consist of coiled tubes. 

7. The two Vasa Deferektia are seen running be- 
twixt the vesiculae seminales, and united to them and to 
the base of the prostate. Their union forms the Ducti 
Ejaculatorii. Observe that part of the bladder left 

20 




230 PKACTICAL ANATOMY. 

between these tubes, and connected by cellular substance 
to the rectum, which is pierced when the bladder is punc- 
tured from the latter part, no peritoneum intervening. 

Fig. 76. 

Base of the Bladder with the Vesicul^ Seminales, Ureters, and 
Prostate Gland. 



1. Muscular Structure of the Bladder. 
2,2. Ureters. 
3, 3. Vasa Deferentia. 

4. Vesicula Seminalis. 

5. Same of the opposite side, dissected 

out to show its tubular character. 

6. Efferent Duct of the Vesicula Semi- 

nalis, which joins the Duct of the 
Vas Deferens to form at 7 the Duc- 
tus Ejaculatorius. 

8. Prostate Gland. 

9. Urethra. 



8. The Corpora Cavernosa Penis arise, on each side, 
by a process named the Crus, from the ramus and from 
the tuber ischii, ascend along the ischium and pubis, and 
are united immediately before the cartilaginous arch of 
the pubis. They consist of erectile tissue, covered by a 
strong, white, fibrous substance, which is very elastic. 
Internally they are cavernous, and are separated from 
each other by a septum, which, from being perforated, is 
named Septum pectiniforme. 

By the union of the two corpora cavernosa, two grooves 
are formed : (1.) A smaller one above, in which two ar- 
teries pass, 1 a large vein or two betwixt them, and some 
large twigs of nerves. (2.) A larger groove below, which 
receives the urethra. 

9. The prepuce is a fold of skin forming a sheath or 
covering for the glans penis. It makes a duplicature 
extending along the flat part of the glans from its basis 
to the orifice of the urethra, termed Fr^enum Prjdputit. 

1 Arteria Dorsalis Penis. It is the termination of the internal pudic 
artery. 



MALE PELVIS. 
Fig. 77. 



231 




A Side View of the Viscera of the Male Pelvis, in situ. The Right 
!l>ide of the Pelvis has been removed by a Vertical Section made 
through the pubis near the symphysis, and another through the 
middle of the sacrum. 

1. Th*j Divided Surface of the Pubis. 

2. The Divided Surface of the Sacrum. 

3. The Body of the Bladder. 

4. Its Superior Fundus ; from the Apex is seen passing upwards the 

Urachus. 

5. The Inferior Fundus of the Bladder. 

6. The Ureter. 

7. The Neck of the Bladder. 

8, 8. The Pelvic Fascia ; the Fibres immediately above 7 are given off 
from the Pelvic Fascia, and represent the Anterior Ligaments of 
the Bladder. 
9. The Prostate Gland. 

10. The Membranous Portion of the Urethra, between the two Layers 

of the Deep Perineal Fascia, or the Triangular Ligament. 

11. The Triangular Ligament, or Deep Perineal Fascia formed of two 

Layers. 

12. One of Cowper's Glands between the two Layers of the Triangular 

Ligament, and beneath the Membranous Portion of the Urethra. 

13. The Bulb of the Corpus Spongiosum. 

14. The Body of the Corpus Spongiosum. 

15. The Right Crus Penis. 

16. The Upper Part of the Rectum. 

17. The Recto-vesical Fold of Peritoneum. 

18. The Middle Portion of the Rectum. 

19. The Right Vesicula Seminalis. 

20. The Vas Deferens. 



232 PRACTICAL ANATOMY. 

21. The Rectum covered by the Descending Layer of the Pelvic Fas- 
cia, just as it is making its bend backwards to terminate in the 
Anus. 

10. The Vesica Urinaria, or Urinary Bladder, is 
situated within the pelvis, immediately behind the ossa 
pubis and before the rectum. It is covered on its upper 
and back part by a reflection of peritoneum ; in front and 
below (where it is contiguous to the rectum) it is con- 
nected by cellular membrane to the surrounding parts. 
Shape, oval, but flattened before and behind, and, while 
in the pelvis, somewhat triangular. Divided into the 
Fundus or bottom, Corpus or body, and Cervix or 
neck. At the top of the bladder, above the symphysis 
pubis, may be observed the superior ligament cff the 
bladder, consisting of the Urachus, a ligamentous cord, 
which runs up between the peritoneum and linea alba as 
far as the navel and two of the ligamentous cords, which 
are the remains of the umbilical arteries, and run up from 
the sides of the bladder. The bladder is also connected 
in front by two ligaments formed by the pelvic fascia, 
and passing to the viscus from either side of the sym- 
physis, and on its sides also by the pelvic fascia. 

Observe the parts of the bladder not covered by peri- 
toneum, as they are the situations of surgical operations. 
These are the whole anterior surface, lying against the 
pubis, and rising above it, when the bladder is distended, 
so that it may be punctured above the pubis ; the sides, 
at the very lowest part of which the cut is made in the 
lateral operation of lithotomy, and where the viscus may 
be punctured from the perineum ; and the inferior sur- 
face, resting on the rectum, and allowing us to puncture 
from it. Observe also the direction of the axis of the 
bladder, in conformity with which all instruments should 
be introduced; this is in a line drawn from the navel to 
the os coccygis. 

11. The entrance of the ureters into the bladder on the 
outside of the vesiculse seminales. 

12. The rectum, following the curve of the os sacrum 
and os coccygis. 

To have a more connected view of the relative situa- 



ARTERIES. 203 

tion of these important parts, one side of the pelvis should 
now be removed by dividing the symphysis pubis, and 
by sawing through the os ileum, or separating it at its 
junction with the sacrum. By carefully removing all 
the cellular membrane, the student will be enabled more 
accurately to examine the situation of the parts above 
described. 



OF THE VESSELS AND NERVES CONTAINED WITHIN THE 

PELVIS. 

1. Arteries. 

The A. Iliaca Interna, having left the trunk of the 
iliaca communis, passes immediately into the pelvis, where 
it gives off several large arteries. 

1. A. Ileo-Lumbalis supplies the psoas and iliacus 
internus muscles. 

2. A. Sacr^e Later ales, two or three small vessels 
which supply the sacrum, cauda equina, and neighboring 
parts. 

3. A. Glutea (or iliaca posterior), a very large branch, 
passes out of the pelvis through the upper part of the 
sciatic notch to supply the haunch ; but, in its passage, it 
gives some branches to the os sacrum, os coccygis, the 
rectum, and the muscles situated within the pelvis. 

4. A. Sciatica passes out of the pelvis by the sciatic 
notch and below the pyriformis muscle to supply the 
hip ; in its passage it gives branches to the neighboring 
parts. 

5. A. PUDICA (pudenda communis or interna) is the 
branch of the internal iliac or ischiatic, which is more 
immediately destined to supply the parts of generation, 
perineum, and lower part of the rectum. It goes out of 
the pelvis above the superior sacro-sciatic ligament, twists 
round it, and re-enters the pelvis above and before the 
inferior sacro-sciatic ligament; it then descends on the 
inside of the tuber ischii, ascends on the inner surface of 
the rami of the ischium and pubis, and, reaching the root of 
the penis, divides into two branches. Superficial and deep. 

20* 



234 



PRACTICAL ANATOMY. 

Fig. 78. 




Arteries op the Pelvis. 



1. Termination of the Aorta. 

2. Middle Sacral Artery. 

3. A Lumbar Artery. 

4. Primitive Iliac Artery. 

5. External Iliac Artery. 

6. Circumflex Iliac Artery. 

7. Epigastric Artery. 

8. Remains of the Umbilical Ar- 

tery of the Foetus converted 
into a Ligament. 



9. Obturator Artery. 

10. Vesical Artery. 

11. Ilio-lumbar Artery. 

12 and 13. Lateral Sacral Arteries. 

14. Gluteal Artery. 

15. Middle Hemorrhoidal Artery. 

16. Internal Pudic Artery. 

17. Ischiatic Artery. 



(1.) A. Superficial Perineal, a branch, which gives 
twigs to the bulb of the urethra and neighboring muscles 
and skin. Noticed in the dissection of the perineum. 

(2.) Arteria Bulbosi, to the bulbous part of the 
urethra. 

(3.) A. Cavernosi, to the cavernous bodies. 

(4.) A. Dorsalis Penis passes under the arch of the 
pubis, runs along the dorsum penis, and is distributed to 
the integuments. 

While in the pelvis, the pudic gives twigs to the blad- 
der, prostate and rectum. 



VEINS. — NERVES. 235 

2. Veins. 

The veins attend the arteries and their ramifications ; 
they unite to form the internal iliac vein, except the veins, 
from the rectum, named hcemorrhoidales, which ascend 
along its back part to join the inferior mesenteric vein. 

3. Nerves. 

The nerves met with in this dissection consist of nu- 
merous twigs sent off from the lumbar and sacral nerves 
to supply the parts about the pelvis. 

But, in this dissection, we meet with three pair of large 
nerves, which have their course through the pelvis, and 
pass to the thigh. 

1. Course of the Anterior Crural Nerve while in 
the pelvis. The anterior crural nerve is formed by 
branches of the first, second, third, and fourth lumbar 
nerves; at its origin, it lies under the psoas magnus, and, 
as it descends, passes betwixt the psoas magnus and 
iliacus internus, till, having passed under Poupart's liga- 
ment, it emerges from betwixt those muscles, and appears 
on the outer side of the femoral artery. 

2. Course of the Obturator Nerve within the pelvis. 
This nerve is formed by branches of the second, third, 
and fourth lumbar nerves: it lies under the internal 
border of the psoas magnus, descends into the pelvis, and 
goes obliquely downwards, to accompany the obturator 
artery through the thyroid hole. 

3. Course of the Great Sciatic Nerve within the 
pelvis. This nerve arises by branches from the fourth 
and fifth lumbar, and three first sacral nerves, which 
unite together to form the largest nervous trunk in the 
body. The nerve passes betwixt the pyriformis and 
gemini, and thus escapes from the back part of the pelvis 
by the sciatic notch. Sometimes one of the branches 
goes through the pyriformis, and joins the sciatic trunk 
at the back of the pelvis. 



236 PRACTICAL ANATOMY. 



OF THE SCROTUM. 

The scrotum consists externally of a loose, rugose 
skin, and internally of the Dartos, consisting of unstriped 
muscular tissue. 

On dividing the anterior part of the scrotum, on either 
side of the raphe, we expose a grayish coat, which is the 
Tunica Vaginalis Testes. 1 Eemoving this, another 
very dense coat, the Tunica Albuginea, within which 
may be seen the proper glandular structure of the testes, 
having on its upper edge an appendage termed Epididy- 
mis, a little enlarged above and below the Globus Ma- 
jor and Minor, all of which are convoluted tubes. 

2. The Spermatic Cord, connecting the testicle to the 
abdominal ring. It consists of, 

a. The spermatic artery, a branch of the aorta; this 
divides into several branches, which enter the upper edge 
of the testicle. 

b. The spermatic veins, which form a plexus that ter- 
minates in the abdomen in a single vein. 

c. The spermatic nerves, which come from the sympa- 
thetic and lumbar nerves. 

d. The vas deferens, or excretory duct of the testicle. 
This is situated in the back part of the cord, and is dis- 
tinguished by its firm cartilaginous feel. 

e. These parts are all connected by cellular membrane, 
and by the tunica vaginalis, which is covered by a thin 
muscle. 

/. The cremaster. This arises from the obliquus de- 
scendens internus, and is lost on the tunica vaginalis. 

It is well now to take out the bladder and penis, and, 
laying them open by an incision which shall pass through 
the upper wall of the urethra and bladder, notice the in- 
ternal appearance. The bladder consists of four coats, 
the peritoneal one, as has been stated, incomplete; the 
others are muscular, cellular, and mucous. The muscular 

1 Tunica vaginalis is derived from the peritoneum, carried down in 
the descent of the testicle ; it consists, therefore, like all serous mem- 
branes, of two layers, with a cavity within. The outer layer is the 
tunica vaginalis reflexa ; the internal one, the tunica vaginalis propria. 



MUSCLES OF THE URETERS. 



237 



coat consists of fibres running in different directions. 
The mucous coat is generally found thrown into folds in 
the undistended state of the organ. Some distance be- 
hind its neck is a smooth triangular surface, the Vesical 




A View of a Portion of the Inside of the Bladder, with the Prostate 
grland appended to it by the attachment of the common tendon of 
the Muscles of the Ureters. 

1,1. Inside of the Bladder. 

2. Lower Fundus. 
3, 3. Mouths of the Ureters. 

4, 4. Muscles of the Ureters, from which the Mucous Membrane has 
been dissected. 

5. Junction of the Muscles at the apex of the Vesical Triangle. 

6. Tendon of the United Muscles. 

7. Middle Lobe of the Prostate and Point of Insertion, according to 

Sir Charles Bell. 

8. Caput Gallinaginis, the Point of Insertion according to Dr. 

Horner. 



238 



PRACTICAL ANATOMY. 



Triangle. The entrance of the ureters corresponds to 
the posterior angles, and the month of the urethra to the 
apex or anterior angle. The sides of this triangle are 
sometimes ridged up ; and, if the mucous membrane be 
removed, a few muscular fibres are sometimes seen, which 
have been described as *the muscles of the ureters. A 
pointed projection in the orifice of the urethra is the 
uvula vesica. 

Urethra. — The first part of the urethra passes through 
the prostate gland, which, having in its structure much 
unstriped muscular tissue, can compress it. This portion 
is called the prostatic portion. In this part we have a 
prolonged elevation of its mucous membrane, the Caput 



Fig. 80. 

The Prostatic, Membranous, and Part of the Spongy Portion of the 

Urethra with Part of the Bladder. 

Internal Surface of the Bladder. 

Vesical Trigone. 

Openings of the Ureters. 

Uvulse Vesicae. 

Urethral or Gallinaginous Crest. 

Opening of the Sinus Pocularis. 

Openings of the Ejaculatory Ducts. 

Openings of the Prostatic Ducts. The 
numbers 7, 7, and 8, 8, are placed 
on the cut surface of the Supra-ure- 
thral portion of the Prostate Gland. 

Lateral Lobes of the Prostate Gland. 

Membranous Portion of the Urethra. 

Cowper's Olands. 

Mouths of the Ducts of the same. 

Commencement of the Spongy Portion 
of the Urethra. 

Upper Surface of the Bulb. 

Roots of the Cavernous Bodies. 

Corpora Cavernosa. 

Spongy Portion of the Urethra. 



Gallinaginis ; on its sides are the openings of the 
Ducti Ejaculatorii. On each sicle of the caput is a 
considerable depression, the Prostatic Sinuses. The 
numerous openings upon their floors are those of the 
Prostatic Ducts. Sinus Pocularis: an opening in front 
of the Caput Gallinaginis. 




LABIA EXTERNA. 239 

Membranous Portion — in advance of the prostatic, 
and is eight to twelve lines in length. 

Bulbous Portion — so much of the urethra as tra- 
verses the bulb. 

Spongy Portion — the remaining part of the canal. 
Just behind its termination is a fossa, the Fossa Navicu- 
lars. Mucous lacunas are scattered over the surface of 
the canal. 

The Glands of Cowper— two little bodies placed be- 
tween the layers of the triangular ligament, and opening 
by two ducts into the anterior part of the bulbous ure- 
thra. 



CHAPTEE XIV. 

DISSECTION OF THE ORGANS OF GENERATION IN THE 
FEMALE. 

Previous to the dissection, it will be proper to exa- 
mine the external parts. 

The Mons Veneris is a rounded prominence, covered 
with hairs after puberty. It consists of the common in- 
teguments, with an additional quantity of cellular and 
adipose substance, and lies upon the forepart of the ossa 
pubis. From the inferior part of the mons veneris arise 

The Labia Externa, called also the labia majora; they 
are continued downwards and forwards in the direction 
of the symphysis pubis and terminate in the perineum 
anterius : they consist of integuments, cellular substance, 
and fat, are thicker above than below, and are red and 
vascular on their inner side. The places where the labia 
are joined to each other above and below, are termed 
Commissures, the lower commissure the Fourchette. 

The longitudinal cavity, or fissure, situated betwixt the 
labia, and extending from the mons veneris to the perineum 
anterius, is sometimes called the Sinus Pudoris; it is 
broader above than below, and contains several other 
parts. 

On separating the labia, we see, immediately below the 
superior commissure. 



240 PRACTICAL ANATOMY. 

Fig. 81. 
The Vulva. 




1. Mons Veneris. 

2. Right Labium. 

3. Right Nympha. 

4. Clitoris, of which only the Ante- 

rior extremity is seen. 

5. Vestibule. 

6. Orifice of the Urethra. 

7. Commencement of the Vagina. 

8. Fourchette. 

9. Navicularis Fossa. 

10. The Anus. 

11. Perineum. 



The Clitoris, a red projecting body, situated below 
the arch of the pubis, and partly covered by its Prepuce. 
The prepuce is a fold of skin, continued from the inner 
surface of the labia, so as to cover the superior and lateral 
part of the clitoris. The clitoris resembles the penis of 
the male, and consists of two cavernous bodies ; these, 
however, cannot be traced in this stage of the dissection. 
That part of the body which forms an obtuse projection 
externally, is called the GrLANS. 

The Perineum Anterius is that portion of the soft 
parts which extend from the inferior commissure of the 
labia to the anus. 

The Perineum Posterius is the space betwixt the 
anus and point of the os coccygis. 

Labia Interna, or Nymphs, are two prominent dou- 
blings of the integuments, extending from the glans of the 
clitoris to the sides of the vagina. Their external side is 
continued from the inner surface of the labia, and from 
the prepuce of the clitoris. 

Vestibulum — A space bounded above by the clitoridis, 
and laterally by the nymphas. At its lower part we 
see the orifice of the urethra, above the orifice of the 
vagina; it consists of a small rising prominence like a pea, 
in the centre of which is a small opening or hole. 

The Hymen, or Circulus Membranosus, is a thin and 



ERECTOR CLITORIDIS. 241 

extensile membrane, formed by a doubling of the lining 
membrane of the vagina, much contracted in virgins. It 
generally has an opening in its upper part. 

After the destruction of the hymen, in married women, 
we see some irregular projections marking the orifice of 
the vagina, and termed CARUNcuLiE Myrtiformes. 

Behind these is the Vagina, or canal leading to the 
uterus ; at the extremity of which may be felt projecting 
the Os Internum Uteri, or Os Tincjs. but it cannot be 
seen without dissection. 

The skin should be now divided on the side of the 
right labium, and the dissection should be carried from 
the groin to the side of the anus ; the cellular membrane 
must be carefully removed, in order to expose the follow- 
ing parts. 

We find the Clitoris consisting of two spongy bodies 
termed Crura, which unite and form the body. The cms 
of each side is a cavernous body, arising from the ramus 
and upper part of the tuberosity of the ischium, con- 
tinued along the ramus of the os pubis, and uniting with 
its fellow opposite to the symphysis pubis. The body 
formed by the crura does not extend upwards, but forms 
a curve downwards towards the urethra; it is divided 
internally by the Septum Pectiniforme, and is attached 
to the symphysis pubis by a suspensory ligament ; it is 
invested by a ligamentous membrane. 

The muscles which are met with in this dissection 
consist of four pair, and two single muscles. 

The Erector Clitoridis, * 

Transversus Perinei, f , . -, 

Levator Ani, ' J on each side. 

COCCYGEUS, ' 

The Sphincter Ani, ) , . , , 

Sphincter Yagin^, [ two ^ muscles ' 
1. The Erector Clitoridis arises, fleshy and tendin- 
ous, from the tuber ischii, from the inside of the ramus 
of the os ischium, and from the ramus of the os pubis ; 
It passes over the crus of the clitoris, and, becoming ten- 
dinous, is lost upon it. 
21 



242 



PRACTICAL ANATOMY. 



Use: To draw the clitoris downwards and forwards, 
and, by compressing it, to propel the blood. 



Fig. 82. 




Muscles of the Female Perineum. 



1, 2, 6. Sphincter Vaginae Muscle. 
3, 4. Erector Clitoridis 
5, 11. Trans versus Perinaei 

7. Levator Ani 

8. Gluteus Maximus 

9. Sphincter Ani 



10. 



12. 
13. 



Junction of the Sphincter 
Ani and Sphincter Va- 
ginas Muscles. 

Adductor Magnus. 

Gracilis. 



Arising from the same point, and surrounded by much 
cellular membrane, we find, 

2. The Transversus Perlnei. — Its origin is the same 
as in the male. 

It is inserted into a ligamentous substance in the 
perineum anterius, at the point where the sphincter ani 
and sphincter vaginas meet. 

This ligamentous or tendinous substance deserves 
attention. Here, as in the male, it is the point of union 
into which muscles are inserted. 

Use: To sustain the perineum. 

3. Surrounding the extremity of the vagina, and a 
small part of the vestibulum, we find the Sphincter 
Yagin^e ; it arises , anteriorly, from the crura of the cli- 



UTERUS, OR WOMB. 243 

toris and pubis on each side ; it surrounds the orifice of 
the vagina, and. is 

Inserted into the ligamentous point of the perineum. 

Use: To contract the mouth of the vagina, and com- 
press the plexus retiformis. 

4. The Sphincter Ani exactly resembles the same 
muscle in the male. 

5. The Levator Ani resembles the same muscle of 
the male ; it surrounds the sides of the vagina in part, 
and consequently assists in constrictiDg and supporting 
it. 

6. The Coccygeus is longer than in the male. 
Under the fibres of the sphincter vaginas you will find 

the Plexus Eetiformis, or Corpus Spongiosum Va- 
ginae, a spongy body, consisting of cellular substance, 
interwoven with a number of convoluted bloodvessels. 
It arises from the sides of the clitoris, passes on each side 
of the extremity of the vagina. 

The Yagina is the canal leading from the vestibnlum 
to the uterus. It lies betwixt the rectum and inferior 
surface of the urethra and bladder, and is connected to 
them by cellular membrane. It is composed of fibro- 
elastic substance, very vascular ; its inner surface is ru- 
gose, and occupied by mucous glands. On slitting it up, 
we see, at its posterior extremity, the Os Uteri, a rounded 
projection, with a transverse fissure. 

The Uterus, or "Womb. — This organ is best seen from 
the cavity of the abdomen. It is situated betwixt the 
bladder and rectum, to both of which it is connected by 
reflections of peritoneum ; it is of the shape of a pear, 
and of a firm consistence. The broad upper part of the 
womb is called the Fundus Uteri, the narrower part is 
named the neck, or Cervix Uteri, and the intermediate 
part its Body. 

If the uterus be slit open, its cavity will exhibit the 
following appearances : Its entrance, the Os Externum, 
moderately large. Then a constricted portion, Cervix, 
which expands into a triangular cavity, at the upper 
angles of which open the Fallopian Tubes. 



244 



PRACTICAL ANATOMY. 



Fig. 83. 
Transverse Section of the Uterus and Part of the Vagina. 




1. Cavity of the Body. 

2. Cavity of the Neck, its walls 

marked by fine oblique ridges. 

3. Cervico-vaginal Orifice (Os Ute- 

ri). 

4. Cervico-uterine Orifice. The two 

bristles are introduced through 
the Orifices of the Fallopian 
Tubes. 



The uterus has four ligaments, two on each side :— 

1. The Ligamentum Teres, or Eound Ligament. It 
is a round long cord, extending from the side of the fundus 
uteri, and passing through the abdominal ring, to be lost 
in the groin. 

The Ligamentum Latum, or Broad Ligament, is a 
broad fold of peritoneum, reflected from the body of the 
uterus, and connecting it on the sides of the pelvis. The 
duplicature of the broad ligament incloses the Fallopian 
tube, ovary, and round ligament. 

The Fallopian Tubes are two. Each tube is con- 
tained in the upper part of the doubling of the broad 
ligament ; it goes out from the fundus of the womb, and 
is a slender hollow tube. Its outer end is curved down- 
wards and backwards, and terminates by a broad fringed 
extremity, termed Morsus Diaboli, or the Fimbriae. — 



OVARIA. — BLADDER. 245 

This broad extremity is connected to the next pair of 




Anterior View of the Uterus and its Appendages. 

1. Body of the Uterus. 

2. Its Superior Border or Fundus. 

3. Its Neck (Cervix). 

4. Its Mouth. (Os Uteri). 

5. The Vagina. 

6, 6. Broad Ligament formed by the Peritoneum, which has been 
removed from the Opposite Side. 
7. Prominence formed by the Subjacent Ovary. 
8, 8. The Round Ligaments, cut where they enter the Internal In- 
guinal Ring. 
9,9. Fallopian Tubes. 
10, 10. Their Fimbriated Extremities — on the Left side tho Extremity 
of the Tube is turned forward, to show its Mouth or Abdomi- 
nal Orifice. 

11. The Ovary. 

12. The Utero-Ovarian or Broad Ligament. 

13. One of the Processes of the Fimbriated Extremity of the Tube 

connected to the Ovary. 

14. Cut Edge of the Peritoneum on the Anterior Surface of the 

Uterus — this Membrane is represented here as descending 
rather lower upon the organ than is really the case. 

The Ovaria are two small oval bodies, white and flat, 
situated by the sides of the uterus, and inclosed in the 
posterior fold of the broad ligament behind the Fallopian 
tube ; each ovarium is connected to the fundus nteri by 
a short round ligament, Ligamentum Ovarii. 

The Bladder is situated before the uterus, and is 
described in the preceding chapter. 

21* 



246 



PRACTICAL ANATOMY. 



The Urethra is short in females (one inch to one and 
a half long), and near the bladder is surrounded by a 
spongy substance. 

The Ureter descends from the kidneys over the psoas 
muscle ; it runs for some space betwixt the bladder and 
vagina, and at last perforates the bladder near the neck. 

Fig. 85. 




Left Half of a Vertical Section of the Female Pelvis, with the 
Rectum, Vagina, and Bladder laid open, and the Uterus turned 
to the Left Side. 



1. 


Bladder. 7. Left Fallopian Tube. 


2. 


Urachus. 8. Left Ovary. 


3. 


Anterior Ligament of the Blad- 9. Uterus. 




der. 10. Vagina. 


4. 


Urethra. 11, 12. Anterior and Posterior Verti- 


5. 


Rectum. . cal Bands or Pillars of the 


G. 


Transverse Folds or Pouches Vagina. 




of the Rectum. 13. Clitoris. 



The Rectum lies behind the uterus. (See the preceding 
chapter.) 



PLEURA. 247 

To obtain a more satisfactory knowledge of the relative 
situation of the parts, the left side of the pelvis should be 
removed as in the male, and the parts examined in that 
situation. 



CHAPTEE XY. 
OF PARTS WITHIN THE THORAX. 

The cavity may be exposed by dividing the cartilage 
from the ribs, and taking these out with the sternum. 

On looking under the sternum, while it is lifted up, we 
see the Mediastinum, separatiDg, as it is gradually torn 
from the posterior surface of the sternum, into two layers, 
and thus forming a triangular cavity. This cavity is 
artificially produced, and is entirely owing to the method 
of raising the sternum. 

When the sternum is laid back or removed, the follow- 
ing parts are to be observed : — 

The Mediastinum, now collapsed, dividing the thorax 
into two distinct cavities, of which the right is the largest. 

The lungs of each side lying distinct in these cavities. 

The pericardium, containing the heart, situated in the 
middle of the thorax, between the two laminae of the 
mediastinum, and protruding into the left side. 

The internal surface of the pleura, smooth, colorless, 
and glistening, lining the ribs, and reflected over the 
lungs. 

1. The Pleura. — Each side of the thorax has its par- 
ticular pleura. The pleurae are like two bladders, situ- 
ated laterally with respect to each other, by adhering to- 
gether in the middle of the thorax, and passing obliquely 1 

1 They run obliquely, not being in general attached to the middle 
of the sternum, but towards its left side, especially at the lower part 
of the bone, near the diaphragm. Besides the pericardium, the 
mediastinum contains betwixt its laminae some adipose membrane 
and absorbent glands. 



248 PRACTICAL ANATOMY. 

from the posterior surface of the sternum to the dorsal 
vertebras, they form the mediastinum. The pleura lines 
the ribs and the upper surface of the diaphragm, and is 
reflected over the lung, which is in fact behind it. It 
forms the Ligamentum Latum Pulmonis, a reflection of 
membrane, which connects the inferior edge of the lungs 
to the spine and diaphragm. 

2. The Lungs. — Color, reddish in children, grayish in 
adults, and bluish in old age. Shape, corresponding to 
that of the thorax, somewhat pyramidal, convex towards 
the ribs, concave towards the diaphragm, and irregularly 
flatted next the mediastinum. 

Division (1.) The Eight Lung is the largest, and is di- 
vided into three lobes, two greater ones, and an inter- 
mediate lesser lobe. 

(2.) The Left Lung has two lobes, and also a square 
notch opposite the apex of the heart. Into the sulci or 
grooves which form the divisions of the lungs into lobes, 
the pleura enters ; that part of the lung which is affixed 
to the spine is called its root ; it is the part by which the 
great vessels, nerves and bronchise enter. 

8. The Pericardium is a strong, white, and compact 
membrane, smooth, and lubricated upon the inside, form- 
ing a bag for containing the heart, and having its inner 
lamina reflected over the substance of the heart itself. 

4. When you slit open the forepart of the pericardium, 
you expose the Heart. The right ventricle protrudes ; 
the right auricle, also, is towards you ; while the left 
auricle is retired, and its tip is seen lapping round upon 
the left ventricle. From under the tip of the left auricle 
a branch of the coronary vein, and one of the coronary 
arteries ramify towards the apex of the heart, marking 
the situation of the Septum Cordis. The left ventricle 
will be found firm, fleshy, and resisting, whilst the right 
ventricle is more loose, and seems partly wrapt round the 
other. 

The heart is situated obliquely in the middle of the 
breast ; its posterior surface is flat, and lies upon the dia- 
phragm ; its apex is turned forwards, and towards the 
left side, so that, in the living bod}^, it is felt striking be- 



LARYNX, TRACHEA, AND LUNGS. 249 



Fig. 86. 




A Front View of the Larynx, Trachea, and Lungs, with the Heart 

INCLOSED IN THE PERICARDIUM. 



1. 

2. 

3. 

4, 5, 6. 

7,8. 

9,9. 

10. 
11. 



Thyroid Cartilage. 

Crico-tliyroid Muscle. 

Trachea. 

Upper, Middle, and Lower 

Lobes of the Right Lung. 
Upper and Lower Lobes of 

the Left Lung. 
Pericardium investing the 

Heart. 
Mediastinum. 
Left Subclavian Artery. 



12. Left Primitive Carotid. 

13. Right Primitive Carotid. 

14. Left Subclavian Artery. 

15. Left Vena Innominata. 

16. Right Vena Innominata. 

17. Right Subclavian Vein. 

18. Right Internal Jugular. 

19. Left Internal Jugular. 

20. Left Subclavian Vein. 

21. Root of the Lungs. 

22. Ligamentum Pulmonis. 



tween the fifth and sixth ribs, at the point where the 
cartilages and bony extremities are united. The "Vena 
Cava Superior is seen coming down from the upper 
angle of the pericardium. The Inferior Cava is 
seen coming up through the diaphragm; but only a 



250 PRACTICAL ANATOMY. 

very small part of this vein is covered by the peri- 
cardium; the two veins enter the right auricle. The 
Eight Auricle is turned forwards, and might be 
called the anterior; it generally appears black, by the 
blood shining through its thin coats. The Eight Ven- 
tricle is situated almost directly opposite. The Pul- 
monary Artery arises from the right ventricle ; its 
root is concealed by the right auricle ; it ascends on the 
left side of the aorta ; it divides into, 1, the right pulmo- 
nary artery, which passes under the arch of the aorta, 
crosses behind it and the vena cava superior to the right 
lung, and is the longest; and, 2, the left pulmonary 
artery, which passes to the left lung, crossing the descend- 
ing aorta anteriorly. The Pulmonary Veins enter the 
left auricle ; two veins come from each lung ; the right 
veins are longest, as they pass behind the vena cava supe- 
rior. The left auricle is situated on the left side of the 
right auricle, and somewhat behind it ; its tip is seen lap- 
ping round upon the Left Ventricle. This is situated 
behind, and on the left side of the right ventricle; its 
substance is stronger and more firm to the touch. The 
Aorta arises from the back part and right side of the 
left ventricle ; its root is covered by the pulmonary 
artery. It then ascends betwixt that artery and the vena 
cava superior. Immediately from the root of the aorta, 
within the pericardium, the two coronary arteries are 
sent off to supply the heart itself. 

DISSECTION of the great vessels of the heart. 

The Vena Cava Superior will be seen descending 
before the root of the lungs, and on the right side of the 
aorta. Immediately before perforating the pericardium, 
it is joined upon its posterior part by the vena azygos, 
which comes forwards from the spine, returning the blood 
from the intercostal spaces. 

Behind the sternum, and just above the arch of the 
aorta, the superior cava is seen receiving two great 
branches. 

1. A branch coming from the right side, formed by 
the right subclavian vein, and the right internal jugular. 



DISSECTION OF THE GREAT VESSELS OF THE HEART. 251 




a. Right Ventricle of the Heart. 
a, a, and 6, b. Pericardium. 

6. Pulmonary Artery, 
c, c. Arch, of Aorta. 

d. Right Auricle. 



Fibrous Remains of the Ductus 
Arteriosus through which 
the Pulmonary Artery of the 
Foetus communicated with 
the Aorta. 



252 PRACTICAL ANATOMY. 

/. Superior cava. q. Right Common Carotid Artery. 

g. Left Brachiocephalic Vein. r. Trachea. 

h. Left Common Carotid Artery, s. Thyroid Gland. 

k. Lower End of the Left Internal t. Brachial Plexus of Nerves. 

Jugular Vein. u. Upper End of left Internal 

1. Right Jugular Vein. Jugular Vein. 

m. Right Subclavian Vein. v, v. Clavicles cut across and dis- 

n. Innominata or Brachio-cepha- placed downward. 

lie Artery. x, x. Fifth Ribs cut across, 

o. Left Subclavian Artery. y, y. Right and Left Breasts. 

p. Right Subclavian Artery cross- z. Lower End of Sternum. 

ed by the Pneumogastric 

Nerve. 

2. A larger branch coming from the left side (Vena 
Transversa or Innominata). It is formed by the left 
subclavian and left internal jugular, which unite to form 
a trunk. This trunk crosses before the arteries arising 
from the arch of the aorta, and then enters the superior 
vena cava. Into the posterior part of the angle formed 
by the union of the left subclavian and the left jugular, 
the thoracic duct empties itself. 

On each side the internal jugular vein descends along 
the neck by the side of the carotid, while the subclavian 
vein comes from the arm. 

The Vena Cava Inferior, immediately after passing 
through the diaphragm £rom the abdomen, enters the 
pericardium. 

The Aorta leaves the heart opposite the fourth dorsal 
vertebra ; it crosses over the pulmonary artery, ascends 
obliquely upwards, backwards, and to the right side, as 
high as the second dorsal vertebra. Here it forms an 
Arch or incurvation, which passes from the right to the 
left side, and at the same time obliquely from before 
backwards. It then comes in contact with the upper part 
of the third dorsal vertebra, and descends along the spine 
in the posterior mediastinum. This arch of the aorta is 
situated behind the first bone of the sternum, behind and 
somewhat below the left branch of the vena cava superior. 

From the upper part of the arch come off three large 
arteries. 

1. The Arteria Innominata, or common trunk of 



POSTERIOR MEDIASTINUM. 253 

the right carotid and subclavian, ascends above an inch, 
and bifurcates into, 

a. The Eight Carotid, which ascends in the neck by 
the side of the trachea. 

b. The Eight Subclavian, which passes outwards to 
the arm. 

2. The Left Carotid. 

3. The Left Subclavian comes off from the extremity 
of the arch. 

The arch of the aorta also gives off some small twigs 
which pass to the pleura, the mediastinum, and thymus 
gland. 

The Thymus Gland is a soft glandular body, lying 
before the lower part of the trachea and great vessels of 
the heart, a little higher than the tops of the two pleurae. 
It is very large in the foetus, smaller in adults, and nearly 
disappears in the aged. 

Where the aorta begins to descend, it is connected to 
the pulmonary artery by a ligament, which, in the foetus, 
was a large canal, the Ductus Arteriosus. 

DISSECTION OF THE POSTERIOR MEDIASTINUM, 1 AND OF 
THE NERVES AND VESSELS WHICH HAVE THEIR COURSE 
THROUGH THE THORAX. 

Course of the Phrenic Nerve through the thorax. — 
On each side this nerve is seen entering the thorax be- 
twixt the subclavian artery and subclavian vein. It then 
proceeds downwards and forwards before the root of the 
lungs, and on the outside of the pericardium, betwixt 
that bag and the pleura. It is lost on the diaphragm. 
This nerve is accompanied by one artery and two veins. 
Some twigs pass from the phrenic nerve into the abdomen, 
to the liver, &o. 

Behind the arch of the aorta and great vessels passing 
from the heart, is seen the Trachea. It enters the 
thorax between the two pleurae, and, opposite the third 

1 By Posterior Mediastinum is designed that part of the mediastinum 
situated behind the root of the limes. 

22 



254: 



PRACTICAL ANATOMY. 



or fourth dorsal vertebra, bifurcates into two parts, 
bronchia, one of which passes toward the right, the 
other toward the left, to enter the lung of each side. 

These bronchiae divide and subdivide, finally ending in 
the Air Cells. The trachea and larger bronchiae consist 
of cartilaginous rings, defective on the posterior third, 
which is tilled up by muscular tissue. 

Fig. 88. 




Terminal Vesicles or the Lung, hanging to a Branch of the Bronchia 
as Berries hang to their Stalk. 



By folding back the lungs towards the left side of the 
chest, we expose the pleura reflected from the under sur- 
face of the root of the lungs to the spine and ribs. A 
triangular space is formed betwixt the two pleurae and 
the bodies of the dorsal vertebras. This space or cavity 
is named the cavity of the posterior mediastinum. It 
contains many important parts, and must, therefore, be 
carefully dissected. 

But first let us attend to the course of the Great Sym- 
pathetic Nerve. 

Cardiac Plexus. — From the three sympathetic ganglia 
of the neck come off three nerves, called the Superior 
Middle, and Inferior Cardiac Nerves. The superior 
cardiac receives filaments from the superior laryngeal 
branch of the par vagum. These nerves, with branches 
also from the recurrent laryngeal of the par vagum, send 
filaments about the great bloodvessels at the root of the 
neck, and afterwards form, between the arch of the aorta 
and the lower part of the trachea, the Cardiac Plexus. 

The Sympathetic Nerve, where it enters the thorax, 




255 



i. A Front View op the Larynx, 
Trachea, and Bronchial Tubes. 

1. Hyoid Bone. 

2. Thyro-hyoid Membrane. 

3. Thyroid Cartilage. 

4. Crico-thyroid Membrane. 

5. Cricoid Cartilage. 

6. Trachea. 

, 8. Two Cartilaginous rings. 
9. Membrane which separates 
them. 

10. Right Bronchus and its di- 

visions. 

11. Left Bronchus. 



B. The Larynx, Trachea, and com- 
mencement of the Bronchial 
Tubes, viewed from behind. 
1. Upper opening of the Larynx. 
2, 3. Lateral grooves of the LaryDx. 

4. Fibrous Membrane of the 

Trachea, interspersed with 
small Grlands, beneath which 
is seen 

5. The Muscular Fibres ; beneath 

this last are seen 
6, 7. Small Fibrous Bands. 

8. The Mucous Membrane seen 
between them. 



is situated behind the great vessels, close upon the 
articulation of the first rib with the body of the first 
dorsal vertebra as it descends along the thorax. It lies 



256 PRACTICAL ANATOMY. 

upon the heads of the ribs, where they are articulated 
with the vertebras. It receives additional branches from 
all the dorsal intercostal nerves, and in each intercostal 
space it forms a ganglion. This nerve may be dissected 
with greater facility when the lungs are removed, and the 
ribs sawed off near the spine, which will enable the dis- 
sector to trace its branches more fully. It lies behind 
the pleura, but is seen through it. - It passes into the ab- 
domen by the side of the spine, running through the 
fibres of the small muscle of the diaphragm. 

BRANCHES OP THE SYMPATHETIC IN THE THORAX. 

The Great Splanchnic Nerve should be attended 
to. It is formed by twigs, which come off from the sixth, 
seventh, eighth, ninth, and tenth thoracic ganglia, and pene- 
trates, with the aorta, the diaphragm. Lesser Splanch- 
nic Nerve, formed by filaments from the tenth and 
eleventh dorsal ganglia, it passes through the crus of the 
diaphragm, and partly uniting with the great splanchnic, 
they together terminate in the Semilunar Ganglion, 
which is formed by a number of smaller ones connected 
by many filaments, constituting the Solar Plexus, and 
placed at the root of the Cceliac Axis. 

The Solar Plexus also receives twigs from the par 
vagum and the phrenic nerves.^ The Phrenic, Hepatic, 
Splenic, Mesenteric, Spermatic, and Eenal Plexuses 
all emanate from the Solar, and are formed by filaments 
winding about the bloodvessels of these parts. 

Lumbar Ganglia — four in number, and connecting 
with the lumbar spinal nerves. 

Hypogastric Plexus is formed by branches from the 
lumbar and aortic plexuses, and is distributed to the 
pelvic viscera. It is situated at the bifurcation of the aorta 
into the iliac arteries, and communicates with branches 
from the fourth and fifth sacral nerves. 

The sacral ganglia are five in number. The nerves of 
the two sides communicate over the coccyx, forming a 
ganglion, the Ganglion Impar. The cranial ganglia, 
six in number, are not described, as the student rarely 



THORACIC DUCT. 



257 



Fig. 90. 
Vena Azygos and Thoracic Duct. 



5,5. 
6. 



7. 



1. External Iliac Vein. 

2. Internal Iliac Vein. 

3. Ascending Cava. 

4. Middle Sacral Vein. 
Lateral Sacral Veins. 
Origin of the Greater Vena 

Azygos in the Lumbar Re- 
gion and from the Lumbar 
Veins. 
Its Trunk. 

8. Its Termination in the De- 

scending Cava. 

9. Lumbar Veins of the Left 

Side, forming at 

10. The Lesser Vena Azygos, 

which terminates at 

11. In the Greater Azygos. 

12. 12. 12. Eight or nine Inferior Inter- 

costal Veins of the Right 
Side, opening into the 
Greater Azygos. 

13. 13. 13. Superior Intercostal Veins, 

opening by a common 
Trunk into the Greater 
Vena Azygos. 

14. 14. 14. Five Inferior Intercostal 

Veins of the Left Side, 
joining the Lesser Azygos. 
15. Receptaculum Chyli. 
16,16,16. Thoracic Duct. 

17. Its Termination in the An- 

gle formed between the 
Left Internal Jugular and 
Left Subclavian Veins. 

18. Right Thoracic Duct. 

19. Subclavian Vein. 

20. Internal Jugular Vein. 




pursues such a dissection iix the limited time which he 
has for his dissecting-room duties. 

99* 



258 PRACTICAL ANATOMY. 

Toward the middle of the spine you see the Yena 
Azygos. In dissecting, it is found situated betwixt the 
right sympathetic nerve and the aorta ; it begins below 
from ramifications of the lumbar veins, which pierce the 
small muscle of the diaphragm. This vein ascends along 
the spine, receiving veins from each of the intercostal 
spaces of the right side ; and, about the middle of the 
back, it receives a considerable trunk, which comes from 
under the aorta, Yena Azygos Minor, and returns the 
blood from the left side of the thorax. At the fourth 
dorsal vertebra, the vena azygos leaves the spine; it 
makes a curve forward, and empties its blood into the 
back part of the vena cava superior, immediately before 
that vein enters the pericardium. The superior intercos- 
tal veins on the left side empty into the vena azygos also. 

Descending through the posterior mediastinum will be 
also found the Aorta. This great artery, having formed 
its arch, comes in contact with the third dorsal vertebra, 
and is now called the Descending Aorta, or Thoracic 
Aorta. It descends along the bodies of the dorsal verte- 
brae, rather on their left side ; it lies behind the oesopha- 
gus, and passes betwixt the crura of the diaphragm into 
the abdomen. 

BRANCHES OF THE AORTA IN THE THORAX. 

1. The A. Intercostalis Superior, on the right side, 
is mostly sent off by the subclavian, on the left side by 
the aorta. 

The Inferior Intercostals are eight or nine in number 
on each side of the thorax ; they come off separately from 
the side or back part of the aorta, and seem to tie that 
great artery to the spine. Each intercostal artery passes 
immediately into the interval betwixt two ribs, and there 
subdivides into 

(1.) A branch which perforates between the heads of 
the ribs to the muscles of the back ; this branch also 
gives twigs which enter the spinal canal. 

(2.) The continued trunk of the artery runs forwards, 
in the interval of the two ribs, giving many branches to 



(ESOPHAGUS. 259 

the intercostal muscles. When it reaches the anterior 
part of the thorax it is lost in the muscles. 

Each intercostal artery is accompanied by one or two 
veins, branches of the vena azygos, and by an intercostal 
or dorsal nerve. 

2. A. Bkonchiales, are two, sometimes three, small 
twigs of the aorta, one of which passes to the lungs on 
each side. 

3. Small arteries pass forwards from the aorta on the 
oesophagus, named A. (Esophagese; others run to the 
pericardium and pleura. 

The dissector also finds in the posterior mediastinum 
the Thoeacic Duct. He must look for it behind the oeso- 
phagus, betwixt the vena azygos and aorta. It is collapsed, 
and appears like cellular membrane condensed, and can 
only be distinguished when inflated or injected; it was 
seen in the abdomen close to the aorta, and passing into 
the thorax between the crura of the diaphragm. It 
ascends along the posterior mediastinum, and, about the 
fourth dorsal vertebra, passes obliquely to the left side, 
behind the aorta descendens, and behind the great arch 
of the aorta, until it reaches the left carotid artery. It 
runs behind this artery and behind the left internal jugu- 
lar vein; and, after forming a circular turn or arch, it 
descends and enters the left subclavian vein at the point 
where that vein is joined by the left internal jugular. 
The absorbents of the right superior extremity, and of 
the right side of the head and thorax, usually form a 
trunk, which enters the right subclavian vein. 

The (Esophagus is also situated betwixt the layers of 
the posterior mediastinum. It lies immediately before 
the aorta, but rather towards its left side ; it is seen de- 
scending from the neck behind the trachea; it passes 
through an opening in the lesser muscle of the diaphragm, 
and immediately expands into the stomach. 

Behind the trachea and vessels going to the lungs, and 
on the forepart of the oesophagus, we meet with a con- 
geries of lymphatic glands. Its muscular fibres are ar- 
ranged longitudinally and circular. 



260 PBACTICAL ANATOMY. 



Course of the Par Vagum, or Eighth Pair of Nerves, in 
the Thorax. 

From the neck, the par vagum passes betwixt the sub- 
clavian vein and artery into the thorax ; it immediately 
sends off a large branch, the Kecurrent Nerve, back 
into the neck. On the right side, this branch twists 
round under the arteria innominata; on the left side, 
under the arch of the aorta, it ascends behind the carotid, 
and lodges itself betwixt the trachea and oesophagus, to 
both of which it gives branches, and to the muscles of the 
larynx. 

The par vagum, having given off the recurrent, de- 
scends by the side of the trachea and behind the root of 
the lungs. It here sends off numerous filaments to the 
lungs, which, uniting with twigs from the great sympa- 
thetic, form the Anterior and Posterior Pulmonary 
Plexuses. These plexuses lie on the anterior and pos- 
terior surfaces of the root of the lungs. Other twigs of 
the par vagum pass to form the inferior Cardiac Plexus 
about the pericardium. 

The trunk of the eighth pair soon reaches the oesopha- 
gus ; the left par vagum runs on the forepart of the oeso- 
phagus, the right nerve on its back part. Here they 
split into several branches, which unite again and form a 
Plexus. This plexus is called the (Esophageal. The 
two nerves continue their course along the oesophagus, 
and pass with it through. the diaphragm, to ramify on 
the stomach and form the stomachic plexus. 

The twelve dorsal or intercostal nerves are also seen 
in this dissection emerging from the spinal canal, between 
the bodies of the vertebrae, and supplying the intercostal 
muscles, &c. 

DISSECTION OF THE HEART WHEN REMOVED FROM THE 
BODY. 

The heart consists of three tunics or coats. 1. An ex- 
ternal smooth one, Exocardium, which is a reflection of 



RIGHT VENTRICLE. 261 

the internal lamina of the pericardium. 2. A middle 
muscular coat. 3. A smooth internal coat, Endocar- 
dium, which is a continuation of the internal coat of the 
great veins and arteries. In the right side of the heart we 
always meet with a considerable quantity of coagulated 
blood. In the left side there is much less. 

Slit open, with the scissors, the two venas cavse on their 
forepart, the inner surface of these veins and of the right 
auricle will be seen lined by a smooth membrane ; and in 
the auricle the musculi pectinati, or bundles of muscular 
fibres, will be seen projecting in the auricular appendage. 
At the point of union between the two cavse, there is a 
projection formed by the thickening of the muscular coat, 
the Tuberculum Loweri. The Septum Auricularum 
is seen separating the right from the left auricle. Ob- 
serve that it is thin, that in it there is an oval depression, 
named Fossa Ovalis. Bound this fossa the fibres are 
thicker, forming the annulus ovalis ; this is the remains 
of the Foramen Ovale of the foetus. The Eustachian 
Yalve is a membrane-like duplicature of the inner coat 
of the auricle, observed where the vena cava inferior is 
continued into the auricle, and stretching from that vein 
towards the opening into the right ventricle. Behind 
this valve is the orifice of the Coronary Vein, with its 
small valve. 

The Foramina Thebesii are minute orifices, some of 
which are veins, which open into all the cavities of the 
heart; they are most numerous, however, in the right 
auricle. 

The Ostium Venosum, or opening of the right auricle 
into the right ventricle, is somewhat oval ; it has a valve 
which projects into the right ventricle. 

The Eight Ventricle may now be opened by an in- 
cision, carried from the root of the pulmonary artery 
down to the apex of the heart. This incision should be 
made with care, lest the parts on the inside of the ven- 
tricle be destroyed by it. It should pass along the right 
side of the septum ventriculorum, the situation of which 
is marked out by large branches of the coronary artery 
and vein. A small opening should first be made, into 



262 



PRACTICAL ANATOMY. 



which one blade of the scissors can be introduced. The 
incision may be continued through the apex of the heart, 
or a flap may be made by another cut, passing from the 
beginning of the first along the margin of the right au- 
ricle. In this ventricle, observe the projecting bundles 
of muscular fibres, the Tricuspid Yalves arising from 
the margin of the ostium venosum, and projecting into 
the right ventricle. This valve forms a complete circle 
at its base, but has its edge divided into three parts, 
which are attached by tendinous filaments, named 
Chords Tendine^e, to the Carneje Columns, or mus- 
cular bundles of the ventricle. 

Fig. 91. 
A View of the Interior of the Right Auricle and Right Ventricle. 




1. The Right Ventricle. 

2. Tricuspid Valve. 

3. Chordae Tendinese. 

4. Pulmonary Artery. 

5. The Aorta. 

6. Descending Vena 
Cava. 

7. The Right Auricle. 
Orifice of the ascend- 
ing Vena Cava. 

9. Vena Cava Ascend- 
ens. 

Valvula Eustachii. 

Orifice of the De- 
scending Vena Ca- 
va. 

Position of the Tu- 
berculum Loweri. 

Valvula Thebesii 
overhanging the 
orifice of the Coro- 
nary Vein. 



The Septum Ventriculorum, or partition of the two 
ventricles, is marked out externally by two veins run- 
ning from the apex to the basis of the heart. 



LEFT VENTKICLE. 



263 



Slit up the pulmonary artery. Observe how it arises 
from the back part of the right ventricle, how smooth 
the inside of the ventricle becomes as it approaches the 
entrance of the artery, or ostium arteriosum. Observe 
the three Semilunar or Sigmoid Valves. Between the 
valves and wall of the artery are little sinuses, the Si- 
nuses of Valsalva. The bases of the valves arise from 
the artery, their loose edges project into its cavity, and 
in the middle of the loose edge of each valve is seen a 
small white body, termed Corpus Sesamoideum Arantii. 
The artery is seen bifurcating into the right and left pul- 
monary arteries, and, just before its bifurcation, sending 
off to the aorta the ductus arteriosus, which in the adult 
is a ligament. 

The Left Auricle has four pulmonary veins opening 
into its cavity, which may be exposed by slitting up two 
of those veins. Observe that its coats are thicker than 



Fig. 92. 

A View of the Left Ventricle laid opex. 



1. Parietes of the Ventricle. 

2. Its Cavity. 

3. Mitral Valve. 

4. Chordse Tendinese. 

5. Coluninge Carneae. 

6. Right Auricle. 

7. Left Auricle. 

], 8. The Four Pulmonary Veins. 

9. Aorta. 

10. Pulmonary Artery. 




those of the right auricle. The septum auricularum, 
with the fossa ovalis, is here seen less distinctly than on 
Observe also the ostium venosum, open- 



the right side. 



264 PRACTICAL ANATOMY. 

ing into the left ventricle, and giving attachment to the 
Valvula Mitralis. 

The Left Ventricle may be opened in the same 
manner as the right by an incision carefully made in the 
left side of the septum or partition of the ventricles, and 
continued round the upper part of the ventricle under the 
auricle. Observe the great thickness of the muscular 
coat ; the Yalvula Mitralis, forming two projections, 
which are attached by the chordae tendinese to the fleshy 
columns of this ventricle. 

Slit up the aorta. It has three semilunar valves, which 
resemble those of the pulmonary artery. Behind these 
valves the artery bulges ont, as in the pulmonary, form- 
ing the Sinuses of the aorta. Above two of the valves 
lie the orifices of the two coronary arteries, of which the 
left is the largest. 



CHAPTER XVI. 

DISSECTION OF THE MUSCLES ON THE POSTERIOR 
PART OF THE TRUNK AND NECK. 

An incision must be made from the occipital protube- 
rance of the occipital along the spine to the top of the 
sacrum, and the integuments turned off. 

In this dissection we meet with twenty-two distinct 
pairs of muscles, besides a number of small muscles situ- 
ated between the processes of contiguous vertebrae. 

1. The Trapezius — It arises, by a thick round ten- 
don, from the lower part of the protuberance in the mid- 
dle of the os occipitis behind, and, by a thin tendinous 
expansion, from the superior transverse ridge of that 
bone; from the five superior cervico- spinous processes 
by the ligamentum nuchas ; tendinous, from the two infe- 
rior cervical spinous processes, and from the spinous 
processes of all the vertebrae of the back. The fleshy 



LATISSIMUS DORSI. 265 

fibres coming from the neck descend obliquely, while 
those from the back ascend. 

Inserted, fleshy, into the posterior third part of the cla- 
vicle ; tendinous and fleshy, into the acromion, and into 
the upper edge of all the spine of the scapula. The fibres 
slide over a triangular surface at the extremity of the 
spine of that bone. 

Situation: This muscle is quite superficial, and con- 
ceals all the muscles situated in the posterior part of the 
neck and upper part of the back. The Ligamentum 
Nuch^e vel Colli is a ligament which arises from the 
middle of the occipital bone, runs down on the back part 
of the neck, adhering to the spinous processes of the 
cervical vertebrae, and giving origin to the fibres of the 
trapezius and of other muscles. 

Use: To move the scapula in different directions. The 
superior fibres draw it obliquely upwards, the middle 
transverse ones draw it directly backwards, and the infe- 
rior fibres move it obliquely downwards and backwards. 

It should be reflected from the spine and head. 

2. The Latissimus Dorsi — Arises, by a broad thin ten- 
don, from all the spinous processes of the os sacrum and 
of the lumbar vertebrae ; from the spinous processes of 
the seven inferior dorsal vertebras; from the posterior 
part of the spine of the os ilium ; also from the extremi- 
ties of the four inferior ribs, by four distinct fleshy digi- 
tations, which intermix with those of the obliquus exter- 
nus abdominis. The inferior fleshy fibres ascend obliquely; 
the superior run transversely. They pass over the infe- 
rior angle of the scapula (from which the muscle often 
receives a thin fasciculus of fibres) to reach the axilla, 
where they are all collected and twisted. 

Inserted, by a strong flat tendon, into the inner edge of 
tfle groove in the os humeri, which receives the long ten- 
don of the biceps flexor cubiti. 

Situation: Where this muscle arises from the dorsal 
vertebrae it is concealed by the origin of the trapezius. 
The remainder of it is placed immediately under the 
skin, and covers the deeper seated muscles of the loins 
and back. The tendon of this muscle, with the subjacent 
23 



266 



PRACTICAL ANATOMY. 
Fig. 93. 




The Fikst and Second and Part of the Third Layer of Muscles of the 
Back, the First Layer being shown upon the Right and the Second 
on the Left Side. 



1. Trapezius Muscle. 

2. Tendinous portion of the same, 

which, with the correspond- 
ing portion of the opposite 
Muscle, forms a Tendinous 
Ellipse on the lower part of 
the Back of the Neck. 

3. Acromion Process and Spine of 

the Scapula. 

4. Latissimus Muscle. 

5. Deltoid. 

6. Infra spinatus and Teres Minor 

Muscles. 



7. External Oblique of the 

Abdomen. 

8. Gluteus Medius Muscle. 

9. Gluteus Magnus. 

10. Levator of the Scapula. 
11,12. Rhomboid Muscles (Small 

and Large). 
13, 14. Splenius Muscle. 

15. Aponeurosis covering the 

Spinal Erector Muscles. 

16. Serratus Inferior Posticus 

Muscle. 

17. Supra-spinous Muscle. 



LEVATOR SCAPULA. 267 

tendon of the serratus posticus inferior, assists in forming 
the fascia lumborum. 

Use : To pull the arm backwards and downwards, and 
to roll the os humeri. 

It should be reflected from the spine, pelvis, and ribs. 

Remove the trapezius and latissimus dorsi, and two 
muscles will be seen passing from the neck to the sca- 
pula. 

3. The Rhomboideus. This muscle is divided into 
two portions. 

(1.) Rhomboideus Major (the inferior portion) arises, 
tendinous, from the spinous processes of the four or five 
superior dorsal vertebras. 

Inserted into all the base of the scapula below its spine, 
extending as far as its inferior angle. 

(2.) Rhomboideus Minor (the superior portion) arises, 
tendinous, from the spinous processes of the three infe- 
rior vertebras of the neck, and from the ligamentum 
nuchas. 

Inserted into the base of the scapula, opposite to the 
triangular plain surface at the root of the spine. 

Situation: This muscle lies beneath the trapezius and 
latissimus dorsi. 

Use: To draw the scapula obliquely upwards and di- 
rectly backwards. 

The rhomboidei should be reflected from the spine. 

4. The Levator Scapulje — Arises from the trans- 
verse processes of the five superior vertebras of the neck 
by five distinct tendinous and fleshy slips, which unite 
and form a considerable muscle. 

Inserted, tendinous and fleshy, into the base of the sca- 
pula, above the root of the spine and under the superior 
angle. 

Situation: This muscle is concealed by the trapezius 
and sterno-mastoideus ; but a small part of its belly may 
be seen in the space between the edges of these muscles. 

Use: To draw the scapula upwards and a little for- 
wards. 

Detaching the rhomboideus from its origin in the 



268 PRACTICAL ANATOMY. 

spine, you will see another muscle passing from the 
whole of the basis of the scapula. 

5. The Serratus Magnus — Arises, by nine fleshy 
digitations, from the nine superior ribs. These digita- 
tions are seen on the anterior part of the thorax ; they 
pass obliquely backwards, and form a strong fleshy 
muscle. 

Inserted, principally fleshy, into the whole of the base 
of the scapula. 

Situation: This muscle lies between the scapula and 
the ribs. The lower digitations, which pass more ante- 
riorly than the edge of the latissimus dorsi, are intermixed 
with the superior digitations of the obliquus extern us 
abdominis. 

Fig. 94. 




The Serratus Major Anticus Muscle. 

Use : To move the scapula forwards, and, when the 
scapula is forcibly raised, to draw the ribs upwards. 
The removal of the rhomboideus also exposes, 
6. The Serratus Superior Posticus. — This muscle 



SERRATUS POSTICUS INFERIOR. 269 

arises, by a thin broad tendon, from the spinous processes 
of the three inferior cervical vertebras, and of the two 
superior dorsal. 

Inserted, by distinct fleshy slips, into the second, third, 
fourth, and sometimes the fifth ribs, a little beyond their 
angle. 

Situation : This muscle is concealed for the most part 
by the rhomboideus and scapula. 

Use : To elevate the ribs, and dilate the thorax. 

Reflect it from the spine. 

7. The Splenitis is divided into two portions. 

(1.) The Splenius Capitis — Arises, tendinous, from the 
spinous processes of the two superior dorsal, and five in- 
ferior cervical vertebrae. It forms a flat broad muscle, 
which ascends obliquely, and is inserted, tendinous, into 
the posterior part of the mastoid process, and into a small 
part of the os occipitis, immediately below its superior 
transverse ridge. 

Situation: This muscle is covered by the trapezius, and 
by the insertion of the sterno-cleido-mastoideus, and a 
small part of it is seen on the side of the neck betwixt 
those two muscles. 

Reflect it from the occiput. 

(2.) The Splenius Colli — Arises, tendinous, from the 
spinous processes of the third, fourth, fifth, and sometimes 
the sixth dorsal vertebrae. It forms a small fleshy belly, 
which ascends by the side of the vertebrae, and is inserted 
into the transverse processes of the four or five superior 
cervical vertebrae, by distinct tendons, which lie behind 
similar tendons of the levator scapulae. 

Situation: This muscle is concealed by the serratus su- 
perior posticus, and splenius capitis. 

Use : To bring the head of the upper vertebrae of the 
neck obliquely backwards. When both muscles act, 
they pull the head directly backwards. 

Reflect it from the dorsal vertebrae. 

8. The Serratus Posticus Inferior — Arises, by a 
broad thin tendon, from the spinous processes of the two 
or three inferior dorsal vertebrae, and from the three su- 
perior lumbar spines by the fascia lumborum. 

23* 



270 



PRACTICAL ANATOMY. 



Inserted, by distinct fleshy slips, into the lower edges of 
the four inferior ribs, at a little distance from their 
cartilages. 

Fig. 95. 




1. Splenitis Capitis. 

2. Complexus Major. 

3. Serratus Posticus Superior. 



Situation: This is a thin muscle, of considerable breadth, 
situated at the lower part of the back, under the middle 
of the latissimus dorsi. Its tendon lies under that of the 
latissimus dorsi, but, although firmly adhering to it, is 
distinct, and may be separated by cautious dissection. 

Use: To pull the ribs downwards and backwards. 

Eeflect it from the spine. 

The Fascia Lumborum is now seen. It is a tendinous 
fascia, arising from the lumbar vertebras and os sacrum, 
giving origin to the lower part of the serratus posticus 



LONGISSIMUS DORSI. 271 

inferior, and to the posterior fibres of the obliquus 
internus and transversalis abdominis. It is also con- 
nected with the tendon of the latissimus clorsi. 

On detaching from the spine of this fascia, and the ser- 
ratus posticus inferior, we expose a thick muscular mass, 
filling up all the space betwixt the spinous processes of 
the vertebras, and the angles of the ribs. This mass con- 
sists of three muscles : — 

(1.) Sacro-Lumbalis on the outside. 

(2.) Longissimus Dorsi in the middle. 

(3.) Spinalis Dorsi close to the spinous processes. 

These three muscles are closely connected together ; so 
that, to effect their separation, it is necessary to divide 
some of the fibres. 

9 and 10. The Sacro-Lumbalis and Longissimus 
Dorsi — Arise, by one common origin, tendinous exter- 
nally, and fleshy internally, from the spinous processes 
and posterior surface of the os sacrum ; from the posterior 
part of the spine of the os ilium, extending nearly as far 
forwards as the highest part of that bone when the body is 
erect; from the spinous processes, and from the roots of 
the transverse processes of all the lumbar vertebrae. 

The thick fleshy belly, formed by this extensive origin, 
ascends, and, opposite to the last rib, divides into the two 
muscles. 

The saero-lumbalis is inserted into all the ribs near 
their angles, by long and thin tendons. The tendons 
which pass to the superior ribs are longer, ascend nearly 
straight, and are situated nearer to the spine than those 
tendons. which pass to the lower ribs. On separating the 
inner edge of this muscle (i. e. the edge next to the spine), 
from the latissimus dorsi, and turning the belly towards 
the ribs, we see six or eight small tendinous and fleshy 
bundles, which pass from the inner side of this muscle, 
to be inserted into the upper edge of the six or eight 
inferior ribs. These are called the Musculi Accessorii ad 
Sacro-Lumbalem. 

Use: To pull the ribs downwards, to assist in erecting 
the trunk of the body, and in turning it to one side. 

The longissimus dorsi is inserted into all the ribs except 



272 



PEACTICAL ANATOMY. 



the two inferior, betwixt their tubercles and angles, by 
slips which are tendinous and fleshy, and into the trans- 
verse processes of all the dorsal vertebrae by small double 
tendons. 

Fig. 96. 
Third Layer of the Muscles op the Back. 




1, 2, 6, 8. Sacro-lumbalis Muscle, 
turned outwards to 
separate it from the 
Longissimus Dorsi, 
which, lies between it 
and the spine. 

3. Point at which these 

two muscles are blen- 
ded in one, the Sacro- 
Spinalis. 

4. Complexus Minor. 

5. Complexus Major. 

7. Trans versalis Cervicis. 



Use: To extend the vertebras, and keep the body 
erect. 

11. The Spinalis Doesi is much smaller than the two 



TRACHELO-MASTOIDEUS. 273 

last described muscles; below, it cannot be separated 
from the longissimus dorsi, without dividing some fibres ; 
it lies betwixt that muscle and the spine. 

Arises, tendinous, from the spinous processes of the two 
superior lumbar vertebra?, and of the three inferior dorsal. 

Inserted into the spinous processes of the nine upper 
vertebra? of the back, except the first, by as many distinct 
tendons. 

Use: To extend the vertebra?, and to assist in raising 
the spine. 

12. The Cervicalis Descendens — Arises from the 
Tipper edge of the four or five superior ribs, by as many 
distinct tendons, which lie on the inside of the tendinous 
insertions of the sacro-lumbalis. It forms a small belly, 
which ascends upwards, and is 

Inserted, by three distinct tendons, into the fourth, fifth, 
and sixth cervical vertebra?. 

Situation: This muscle is small; it is frequently de- 
scribed as an appendage to the sacro-lumbalis. It arises 
between the sacro-lumbalis and longissimus dorsi, and is 
inserted into the transverse processes between the splenius 
colli and levator scapula?. 

Use : To turn the neck obliquely backwards. 

13. The Transversalis Colli — Arises from the trans- 
verse processes of the five superior dorsal vertebra?, by 
five tendinous and fleshy slips, and is 

Inserted, tendinous, into the transverse processes of the 
five or six inferior cervical vertebra?. 

Situation: The origin of this muscle lies on the inside 
of the longissimus dorsi, and is sometimes considered as 
an appendage to it. The insertion is situated between 
the cervicalis descendens and trachelo-mastoideus. 

Use: To turn the neck obliquely backwards, and a 
little to one side. 

14. The Trachelo-Mastoideus lies nearer to the bone 
than the last described muscle. 

Arises from the transverse processes of the three upper- 
most vertebra? of the back, and of the five inferior of the 
neck, by as many thin tendons, which unite and form a 
fleshy belly. 



274 



PRACTICAL ANATOMY. 



Inserted, tendinous, into the posterior surface of the 
mastoid process. 

Situation : This muscle lies on the outside of the corn- 
plexus, and on the inside of the transversalis colli; its 
insertion is concealed by the splenius capitis. 

Use: To keep the head and neck erect, and to draw 
the head backwards, and to one side. 

15. The Complexus — Arises, by tendinous and fleshy 
fibres, from the transverse processes of the seven superior 
dorsal, and of the four or five inferior cervical vertebrae. 
It forms a thick, tendinous, and fleshy belly. 

Inserted, tendinous and fleshy, into the hollow betwixt 
the two transverse ridges of the os occipitis, extending 
from the middle protuberance of that bone, nearly as far as 
the mastoid process. 



Fig. 97. 




1. Cervicalis Descendens. 

2. Semi-spinalis Colli. 

3. Semi-spinalis Dorsi. 

4. Transversalis Colli. 



Situation: This is a large muscle. Its origin from the 
cervical vertebras is nearer to the spine than the trachelo- 
mastoideus; it is covered by the splenius; but a large 



RECTUS CAPITIS POSTICUS MINOR. 275 

portion of it is seen between the splenius and spine, im- 
mediately on removing the trapezius. 

Use: To draw the head backwards, and to one side. 

On removing the complexns from the occiput, we find, 
close to the spine, 

16. The Semi-Spinalis Colli. — It arises, by distinct 
tendons, from the transverse processes of the six superior 
dorsal vertebrae, ascends obliquely close to the spine, and 
is 

Inserted into the spinous processes of all the vertebrae 
of the neck, except the first and the last. 

Situation : This muscle is situated close to the vertebras 
at the posterior part of the neck and back. 

Use : To extend the neck obliquely backwards. 

17. Semi-Spinalis Dorsi — Arises from the transverse 
processes of the seventh, eighth, and ninth vertebrae of 
the back, by distinct tendons, which soon grow fleshy. 

Inserted, by distinct tendons, into the spinous processes 
of the five superior dorsal vertebrae, and of the two lower 
cervical. 

Situation : This muscle lies nearer the spine than the 
lower part of the semi-spinalis colli ; its inferior origins 
lie on the outside of the insertion of the spinalis dorsi. 

Use : To extend the spine obliquely backwards. 

The removal of the complexus brings also in view 
several small muscles situated at the superior part of the 
neck, immediately below the occiput. 

18. The Kectus Capitis Posticus Major — Arises, 
fleshy, from the side of the spinous process of the dentata, 
or second cervical vertebrae. It ascends obliquely out- 
wards, becoming broader, and is 

Inserted, tendinous and fleshy, into the inferior trans- 
verse ridge of the os occipitis, and into part of the con- 
cavity above that ridge. 

Situation: This muscle is situated obliquely between 
the occiput and the second vertebrae of the neck. 

Use: To extend and pull the head backwards, and to 
assist in its rotation. 

19. The Kectus Capitis Posticus Minor — Arises, 
tendinous and narrow, from an eminence in the middle of 



276 



PRACTICAL ANATOMY. 



the back part of the atlas, or first cervical vertebra. It 
becomes broader, and is 

Inserted, fleshy, into the inferior transverse ridge of the 
os occipitis, and into the surface betwixt that ridge and 
the foramen magnum. 

Situation: It is partly covered by the rectus capitis 
posticus major. 

Use: To draw the head backwards. 



Fig. 98. 




1. Rectus Capitis Posticus 

Minor. 

2. Rectus Capitis Posticus 

Major. 

3. Obliquus Capitis Inferior. 

4. Obliquus Capitis Superior. 

5. Interspinals . 



20. Obliquus Capitis Superior — Arises, tendinous, 
from the upper and posterior part of the transverse pro- 
cess of the first cervical vertebra. 

Inserted, tendinous and fleshy, into the inferior trans- 
verse ridge of the os occipitis behind the mastoid process, 
and into a small part of the surface above and below that 
ridge. 

Situation: This muscle is situated laterally between the 
occiput and atlas. 

Use: To draw the head backwards, and to assist in 
rolling it. 

21. Obliquus Capitis Inferior — Arises, tendinous 
and fleshy, from the side of the spinous process of the 
clentata or second cervical vertebra. It forms a thieo- 
belly, and is e 



INTERSPINALBS. 277 

Inserted into the under and back part of the transverse 
process of the atlas. 

Situation: This muscle is obliquely situated between 
the first two vertebrae of the neck. 

Use : To rotate the head, by turniug the first vertebra 
upon the second. 

22. The Multifidus Spin^:. 

On removing the muscles of the spine which have been 
described, we find situated beneath them the Multifidus 
Spinas. It is that mass of muscular flesh which lies close 
to the spinous and transverse processes of the vertebras, 
extending from the dentata to the os sacrum. The 
bundles of which it is composed seem to pass from the 
transverse, to be inserted into the spinous processes. 

Arises, tendinous and fleshy, from the spinous processes 
and back part of the os sacrum, and from the posterior 
adjoining part of the os ileum ; from the oblique and 
transverse processes of all the lumbar vertebras ; from 
the transverse processes of all the dorsal vertebrae ; and 
from those of the cervical vertebrae, excepting the three 
first. The fibres arising from this extensive origin pass 
obliquely to be 

Inserted, by distinct tendons, into the spinous processes 
of all the vertebras of the loins and back, and into those 
of the six inferior vertebras of the neck. The fibres 
arising from each vertebra are inserted into the second 
one above it, and sometimes more. 

Use : To extend the back obliquely, or move it to one 
side. When both muscles act, they extend the vertebrae 
backwards. 

The small muscles situated between the processes of 
the vertebrae are, 

1. Interspinales colli, dorsi, et lumborum. — These 
are small bundles of fibres, which fill up the spaces be- 
tween the spinous processes of the vertebrae. Each of 
these little muscles arises from the surface of one spinous 
process, and is inserted into the next spinous process. 

In the neck they are large, and appear double, as the 

unous processes of the cervical vertebras are bifurcated. 
t 24 



278 PRACTICAL ANATOMY. 

In the back and loins they are indistinct, and are rather 
small tendons than muscles. 

Use: To draw the spinous processes nearer to each 
other. 

2. The Inttertransversales colli, dorsi, et lumborum, 
are small muscles which fill up, in a similar manner, the 
space between the transverse processes of the vertebras. 
In the neck they are bifurcated and distinct, in the back, 
they are small and slender, and in the loins they are 
strong and fleshy. 

Use : To draw the transverse processes towards each 
other. 



CHAPTEE XVII. 

DISSECTION OF THE MUSCLES SITUATED BETWEEN THE 
RIBS, AND ON THE INNER SURFACE OF THE STERNUM. 

The muscles which fill up the space between the ribs 
are named Intercostals ; they are disposed on each side 
of the thorax in two layers, and each layer consists of 
eleven muscles. 

1. The Lntercostales Externt — Arise from the in- 
ferior acute edge of each superior rib, extending from the 
spine to near the junction of the ribs with their cartilages. 
The fibres run obliquely forwards and downwards, and 
are 

Inserted into the upper obtuse edge of each inferior 
rib, from the spine to near the cartilage of the rib. 

Situation: These muscles are seen, on removing the 
muscles which cover the thorax. 

The Levatores Costarum are twelve small muscles, 
situated on each side of the dorsal vertebras. They are 
portions of the external intercostals. Each of these small 
muscles arises from the transverse process of one of the 
dorsal vertebras, and passes downwards, to be inserted 



TRIANGULARIS STERNI. 279 

into the upper side of the rib next below the vertebrae, 
near its tuberosity. 

The first of these muscles passes from the last cervical 
vertebra, the eleven others from the eleven superior 
dorsal vertebras. The three or four inferior Levatores 
are longer, and run down to the second rib below the 
transverse process from which they arise. 

2. The Intercostales Interni — Arise from the infe- 
rior acute edge of each superior rib, beginning at the 
sternum, and extending as far as the angle of the rib. 
The fibres run obliquely downwards and backwards, and 
are 

Inserted into the superior obtuse edge of each inferior 
rib from the sternum to the angle. Portions of the in- 
ternal intercostals pass over one rib, and are inserted into 
the next below it. 

Thus the intercostal muscles decussate, and are double 
on the sides of the thorax ; but, from the spine to the 
angles of the ribs, there are only the external intercostals, 
and, from the cartilages to the sternum, only the internal 
and some cellular membrane covering them. The whole 
of the internal intercostals, and the back part of the ex- 
ternal, are lined by the pleura. 

Use: To elevate the ribs so as to enlarge the cavity of 
the thorax. 

One pair of muscles is situated on the inner surface of 
the sternum. 

The Triangularis Sterni. or Sterno-Costalis — Arises, 
tendinous and fleshy, from the edge of the whole cartilago- 
eusiformis, and from the upper edge of the lower half of 
the middle bone of the sternum. The fibres ascend ob- 
liquely upwards and outwards, and form a flat muscle, 
which is 

Inserted, by three or four triangular fleshy and tendinous 
terminations, into the cartilages of the third, fourth, fifth, 
and sixth ribs. 

Situation : This muscle lies on the inside of the ribs and 
sternum, and is lined by the pleura. 

Use : To depress the cartilages and the bony extremi- 
ties of the ribs, and consequently to assist in lessening 
the cavity of the thorax. 



280 PRACTICAL ANATOMY. 

CHAPTEE XVIII, 
DISSECTION OF THE EYE. 

The eyes of inferior animals, as the bullock's, sheep s, 
or pig's, are generally used for purposes of dissection. 1 

The Ball of the Eye — composed of tunics and hu- 
mors. The anterior part is covered by a mucous mem- 
brane, the Conjunctiva, which is reflected upon the 
eyelids. Clear away all loose structure, and you expose 

The Sclerotic Coat — an exceedingly strong fibrous 
coat. It is perforated behind by several small openings 
for the filaments of the optic nerve, and in front has con- 
nected with it the cornea. 

The Cornea — a transparent membrane, made up of 
numerous laminae. The conjunctiva covers it, though 
altered very much in character. Make an incision 
through the sclerotica, and, introducing a blowpipe, 
force in sufficient air to separate it from the coat beneath; 
then carefully, with a pair of scissors, divide around its 
entire circumference. This accomplished, make a num- 
ber of antero-posterior incisions, and turn back the cut 
portions, under which the ciliary nerves will be seen run- 
ning forward. 

Tunica Choroilea — a dark coat, depending for its 
color upon a layer of pigment cells. This coat is very 
vascular. Where it seems to terminate in front, a white 
line is seen, the Ciliary Ligament. In front of it is 
placed the Iris, and, if this be now torn away, a number 
of vascular fringes will be seen. on its front border. 
These are the ciliary processes. 

The Ciliary Ligament is a line of union between the 
iris with the choroidea, and these again with the sclero- 
tica and cornea. 

Iris — a muscular and vascular body, consisting of 
fibres longitudinal and circular. It is colored with pig- 
mentum nigrum, and the opening in it is the pupil. 

1 They should be floated in a saucer of water when being examined. 




281 



Dissection of the Eye, in which the Sclerotica has been dissected off 
and turned down in order to expose the nerves and some of the 
Bloodvessels. 

1,1. Ciliary Nerves entering the Ciliary Ligament and passing forward 
to the Iris. The Ligament is dissected away in two places to 
show their course. 

2. Smaller Ciliary Nerve. 

3. Vasa Vorticosa, or Veins of the Exterior Layer of the Choroid. 

4. Ciliary Ligament and Muscle. 

5. Converging Fibres of the Greater Circle of the Iris. 

6. Looped and knotted form of these Fibres near the Pupil, the 

knots or enlargements being regarded as Ganglia by Meckel. 
Within them is seen the lesser circle, Sphincter Iridis, with its 
Converging Fibres. 
6. The Optic Nerve. 

Eetina. — If the choroid be dexterously removed, the 
retina is exposed, an exceedingly delicate nervous mem- 
brane. 1 It is connected in front to the lens by its vascu- 
lar layer, the Zonula Ciliabis. 

There are three humors or lenses in the interior of the 
eye. 



1 For its structure and that of the other coats, 
anatomv. 

24* 



see works on special 



282 



PRACTICAL ANATOMY. 



Fig. 100. 

Internal View of the Choroid Coat and Ciliary Processes, as 
a Vertical Section of the Eyeball. 



a, b. Corona Ciliaris, or Ciliary Body, the rays of 
which are adherent to the Choroid at b, 
and free at a. 

s. Sclerotic Coat. 

c. Choroid Coat. 




Vitreous Humor — makes the great bulk of the eye, 
and is situated posteriorly. 

It is inclosed in a delicate capsule, the Hyaloid Mem- 
brane. 

Crystalline Humor is a double convex lens, situated 
on the front part of the vitreous humor, and inclosed in 
a membrane called its capsule. 




A Horizontal Section of the Eye. 

1,1. The Cornea, fitted into the Sclerotica. 

2. Its Posterior Lamina, or Cornea Elastica, forming the Anterior 
Parietes of the Chamber for the Aqueous Humor. 



LIGAMENTS. 283 

3, 3. Sclerotic Coat. 

4, 4. Choroid Coat. 

5, 5. Ciliary Ring or Ligament. 

6. Its Internal Surface, corresponding to the Ciliary Processes. 

7. Ciliary Body, or Corona Ciliaris of the Choroid Coat. 

8. The Iris. 

9. Posterior Chamber of the Aqueous Humor. 

10. Anterior Chamber of the Aqueous Humor. 

11. The Retina. 

12, 12. Termination of the Retina (according to Cruveilhier and others, 
mar go dentatus), at the Posterior Extremities of the Ciliary 
Processes of the Vitreous Body. 

12. The Vitreous Humor. 

13. The Hyaloid Tunic, one layer of which passes behind. 

14. The other in front of the Crystalline Lens. 

15. The Lens. 

16. Canal of Petit. 

17. Optic Nerve, invested by a Sheath from the Dura Mater. 

18. Vitreous Humor, or Corpus Vitreum. 

Aqueous Humor — it has the least consistence of the 
three, and occupies all the space between the crystalline 
lens behind and the cornea in front, filling up the ante- 
rior and posterior chambers of the eye. The communi- 
cation between the two chambers of the eye is the pupil. 



CHAPTER XIX. 
LIGAMENTS. 

If the student designs examining the articulations, they 
should be kept moist after the dissection of the muscles. 

The Ligaments are found either in the form of cords, 
bands, or sacs. The most perfect capsular ligaments are 
those of the shoulder and hip-joints. 

Within the ligaments of movable articulations is a 
lining of serous membrane. The synovial sac which se- 
cretes a tenacious viscid fluid, the Synovia ; designed 
for lubrication of the joints. The student should examine 



284 



PRACTICAL ANATOMY. 



the most important articulations, of which the following 
may be described : — 

Articulation of the Lower Jaw. 

It is formed between the glenoid cavity of the temporal 
bone, and the head of the inferior maxillary bone. 

Fig. 102. 
Articulations of the Lower Jaw. 




1. External Lateral Ligament. 

2. Internal Lateral Ligament. 

3. Inter-articular Cartilage. 



A Capsular Ligament invests the joint, arising 
around the glenoid cavity, and inserted about the neck of 
the inferior maxillary bone. A few additional fibres on 
the inner and outer side of the capsular ligament Lave 
been named the Internal and External Lateral Liga- 
ments. 

Stylo-maxillary Ligament — arises from the styloid 
process, and is inserted on the posterior face of the jaw, 
close to the angle. 

Interarticular Cartilage divides the capsular liga- 
ment, and it is seen placed between the condyle and the 
glenoid cavity. Usually there are two distinct synovial 
sacs, one above and one below this cartilage. 



ARTICULATIONS OF THE SPINE. 



285 



Ligaments of the Spine. 

Anterior Vertebral Ligament extends along the 
front of the spine from the second vertebra to the sacrum. 

Posterior Vertebral Ligament extends from the 
foramen magnum to the sacrum and coccygis, on the 
posterior part of the bodies of the vertebrae, within the 
spinal canal. 

Intervertebral Substance. — Fibrocartilaginous 
disks placed between all the vertebrae except the first two. 
They consist of an exterior part, the fibres of which are 
arranged concentrically, and also oblique, and an interior, 
consisting of a soft pulpy substance. This material is, 
in the connected spine, in a state of compression, as it is 
seen to rise up when the contiguous pieces are removed. 
The Oblique Processes are connected by capsular liga- 
ments, lined by synovial membranes. The spinous pro- 
cesses have ligaments passing between them. Between 
the bony bridges of the vertebrae are placed the ligamenta 
subflava, or yellow elastic ligaments. 

Special Articulations of the Spine. 

Of the Occiput with the Atlas. — The articulating 
processes of each are faced with cartilage, and surrounded 
by a capsular ligament. 



1. Occiput. 

2. Posterior Occipito-at- 

loidean Ligament. 

3. Posterior Atloidean 

Dentate Ligament. 

4. 4. Second Pair of Yel- 

low Ligaments. 




286 



PRACTICAL ANATOMY. 



Occipito-Atloidean Ligament — Arises from the mar- 
gin of the great occipital foramen, and is inserted into the 
upper margin of the Atlas. 

Articulation of the Axis with the Occiput. 

Occipito-Dentate LiGAMENT-^-From the processus 
dentatus to the front of the great occipital foramen. 

Fig. 104. 
The Posterior Arch op the Occiput and two Upper Vertebra. 







1. Basilar Process. 

2. Anterior Condyloid Fo- 

ramen. 

3. Posterior Foramen La- 

cerum. 

4. Transverse Ligament 

of the Atlas. 

5. Its Superior Fascicu- 

lus. 

6. Its Inferior Fasciculus. 

7. Anterior Vertebral Li- 

gament. 



Transverse Ligament stretches across from one side 
to the other of the first vertebra, just behind the pro- 
cessus dentatus. 

Moderator Ligaments — Two in number, and extend 
from the processus dentatus to the inner part of the occi- 
pital condyles. 

Principal Ligaments of the Pelvis. 

Those connecting the sacrum to the vertebrae are called 
Sacro-Vertebral. 

The Coccygeal Ligaments, Anterior and Posterior, 
are placed in front and behind the coccyx. 

Ilio -Lumbar Ligament — From the transverse and ob- 
lique processes of the last lumbar vertebra, to the pos- 
terior part of the crest of the ileum. 



LIGAMENTS. 



287 



Sacroiliac Ligaments. — Bands of fibres which sur- 
round the sacro-iliac junction. 



Fig. 105. 




Articulations of the Pelvis and Hip. 



1. Posterior Sacro-sciatic Liga- 8. 

ment (Vertical Ligament of 9. 
Bichat), arising from the Sa- 
cro-iliac Junction. 

2. Also from the Sacrum and Coc- 10, 11. 

cyx. 

3. Free portion of the Ligament, 12. 

inserted into the Tuber Ischii 13. 

at 4 and 5. 14. 

6. Lesser or Anterior Sacro-sciatic 15. 

Ligament. 16. 

7. Obturator Ligament. 



0s Coccygis. 

Sacral Fasciculus of the 
Posterior Sacro-Sciatic Lig- 
ament. 

Capsular Ligament of the 
Hip-Joint. 

Trochanter Minor. 

Trochanter Major. 

Lesser Sciatic Notch. 

Greater Sciatic Notch. 

Posterior Sacro-iliac Liga- 
ment. 



Posterior Sacro-sciatic Ligament. — From the pos- 
terior inferior spinous process of the ileum, from the sacrum 
and coccyx, to the. inner part of the tuberosity of the 
ischium, and continued towards the pubis. 



288 PRACTICAL ANATOMY. 

Anterior Sacro-Sciatic Ligament. — From the sa- 
crum and coccyx to the spinous process of the ischium. 
Obturator Ligament fills up the foramen thyroideum. 

Articulation of the Pubes. 

Between the bodies of the pubes, fibro-cartilage, and 
in front, bands of fibres passing across from one bone to 
the other. 

Subpubic Ligament placed beneath the arch of the 
pubes. 

Posterior Articulations of the Ribs. 

The ribs are connected to the bodies of the vertebrae 
and intervertebral cartilages by an interarticular liga- 
ment, and an anterior one ; and to the transverse processes 
by ligaments called Costo-transverse Ligaments. 

Anterior Articulation of the Ribs. 

The ribs have small cavities on their anterior extremi- 
ties, into which, fits the corresponding cartilage, and 
strengthened by fibrous bands in front and behind. 

The cartilages of the true ribs are let into cavities in 
the sternum, and strengthened by radiated fibres in front. 

Sterno- Clavicular Articulation. 

The end of the clavicle is placed in a cavity on the edge 
of the sternum; a strong cartilage interposed, and the 
whole articulation encased in a capsular ligament. The 
clavicle is connected also to the first rib or its cartilage, 
the Costo-clavicular or Rhomboid Ligament. 

Scapulo- Clavicular Articulation. 

The Acromioclavicular Ligament. — A capsular 
ligament investing the acromion process and the acromial 
end of the clavicle. 

Coraco-Clavicular Ligament between the coracoid 
process of the scapula and the first rib. It presents the 
appearance of two which have been named the Conoid 
and Trapezoid Ligaments. 



ARTICULATIONS. 
Fig 106. 



289 




Sternoclavicular Articulation. 



1. Capsular Ligament. 

2. Inter-clavicular Ligament. 

3. Costo-clavicular or Rhomboid 

Ligament. 



4, 4. Clavicles. 

5, 6. Costo-sternal or Chondro- 

sternal Ligaments. 



Coraco -acromial Ligament between the coracoid 
and acromion processes. 

Coracoid Ligament across the coracoid notch. 

Scapulo-humeral Articulation. 

Glenoid Ligament around the glenoid cavity of the 
scapula in order to deepen it. 

Capsular Ligament between the margin of the glenoid 
cavity and the neck of the humerus. 

Accessory Ligament. — A simple thickening of the 
capsular ligament between the coracoid process and the 
great tuberosity of the humerus. 

The tendon of the biceps muscle passes through the 
upper part of the cavity on its way through the bicipital 
groove to the arm. 

25 



290 PRACTICAL ANATOMY. 

Fig. 107. 




SCAPULO-HUMERAL ARTICULATION. 

1. Ligamentum Bicorne. 

2. Acromio-clavicular Ligament. 

3. Coraco-acromial Ligament. 

4. Coraco-clavicular Ligament. 

5. Coracoid or Supra-scapular Ligament. 

6. Capsular Ligament. 

7. Tendons of the Supra-spinatus, Infra-spinatus, and Teres Minor 

Muscles. 

8. Tendon of the Long Head of the Biceps. 



Elbow-Joint. 

Capsular Ligament arising from the margin of the 
articular surface of the os humeri and inserted into the 
ulna and coronary ligament of the radius. A thickening 
of its fibres on the inner and outer side of the articulation 
constitutes the External and Internal Lateral Liga- 
ments. 

Coronary Ligament of Kadius passes from one side 
of the lesser sigmoid cavity of the ulna to the other. It 
embraces the neck of the radius. 

Interosseous Ligament, a fibrous membrane stretched 
between the radius and ulna. 

Eound Ligament, from the coronoid process to the 
radius below its tubercle. 



ARTICULATIONS. 291 

Fig. 108. 




The Humero-cubital Articulation. 

1. External Lateral Ligament, blended with the Extensor Ten- 
dons. 

2, 3, 4, 5. Capsular Ligament. 

6. Tendon of the Biceps. 

7. Humerus. 

8. Ulna. 

9. Radius. 

Articulation of the Wrist. 

This includes the connection of the radius and ulna 
below; the first row of the carpus with these; and the 
two rows of the carpus with each other. 

Radio-ulnar Articulation. 

A triangular cartilage extends from the side of the 
radius, and is fixed by a pointed process into the root of 
the styloid process of the ulna. This cartilage separates 
the lower end of the ulna from the cuneiform bone. The 
capsule of fibrous tissue which connects these bones above 
the cartilage is loose-lined with a synovial membrane, and 
called the Sacciform Ligament. The cartilage is often 
perforated by an opening, and the synovial membrane is 
continuous above and below. 



292 



PRACTICAL ANATOMY. 



Radio-carpal Articulations. 

Formed between the radius and the first three bones of 
the first carpal row; it is effected by an Anterior and 
Posterior Kadio-carpal Ligament, and the External 
and Internal Lateral Ligament. The lateral ones 
arising from the styloid processes of the radius and ulna, 
and inserted into the scaphoid, trapezium, and cuneiform 
bones. 

Articulations of the Bones of the Carpus. 

These bones are arranged in two rows, having a com- 
mon synovial membrane, except the pisiforme, and that 
between the trapezium and the metacarpal bone of the 



Fig. 109. 

Articulations op the Bones op the Carpus with each other, and with 
those op the forearm and metacarpus. 

1. Scaphoides. 

2. Lunare. 

3. Cuneiforme. 

4. Pisiforme. 

5. Trapezium. 

6. Trapezoides. 

7. Magnum. 

8. Unciforme. 

9. Radius. 

10. Ulna. 

11. Synovial Membrane of 
the Inferior Radioul- 
nar Articulation. 

12. Synovial Membrane of 
the Radio-carpal Ar- 
ticulation. 

13. Inter-articular Ligament 
between the Ulna and 
Radius, and separat- 
ing the two preceding 
Synovial Membranes. 

Synovial Membrane of the Os Pisiforme. 

Synovial Apparatus between the First and Second Rows of 
Carpal Bones, and between the Second Row and the Meta- 
carpus. 

Synovial Membrane of the Articulation of the Os Trapezium 
with the First Metacarpal Bone. 




14. 
15, 15. 

16. 



CAPSULAR LIGAMENT. 



293 



thumb. The figure will explain. Ligamentous bands 
run in different directions from one bone to the other. 

The Phalangeal Articulations 

May be considered as Capsular Ligaments thickened 
very much on their sides, forming the Lateral Liga- 
ments, and strengthened in front and on the back by the 
sheath for the flexor tendons and the expansion of the 
extensor tendons. 

Articulations of the Hip- Joint. 

It occurs between the acetabulum and the head and 
neck of the femur. 

Capsular Ligament — arising from about the aceta- 

Fig. no. 
View of the Capsular Ligament of the Hip-Joint. 



1. The Capsular Ligament 

is separated from tlie 
Acetabulum, and is 
thrown back to show 
the manner in which 
it invests and qon- 
ceals the neck of the 
Femur. 

2. Ligamentum Teres. 




bulum, and inserted into the neck of the femur, lower in 
front than behind. 

25* 



294 



PRACTICAL ANATOMY. 



Ligament um Teres— a round cord from the pit on 
the head of the femur to the sides of the notch of the 
acetabulum. 

Cotyloid Ligament — surrounds the brim of the ace- 
tabulum as far as the notch. 

Transverse Ligament — subtends the notch of the 
acetabulum. The student will observe a loose vascular 
pad of fat filling up a little space in the bottom of the 
acetabulum. These masses were once considered as 
glands. 

The Knee- Joint. 

An expansion from the tendons of the muscles of the 
thigh incloses this articulation in a loose bag of fibrous 
tissue. 

Fig. 111. 
Front View of the Knee-Joint. 




Will ** ^igamentum Patellae. 
|\J I 2. Internal Lateral Ligament. 
lib 3. External Lateral Ligament. 



The Involucrum. 

External Lateral Ligament — from the external 
condyle to the head of the fibula. 

Internal Lateral Ligament — from the internal con- 



KNEE-JOINT. 
Fig. 112. 



295 




A Longitudinal Section op the Left Knee-Joint, showing the Reflec- 
tion of its Synovial Membrane. 



1. The Cancellated Structure of the lower part of the Femur. 

2. The Tendon of the Extensor Muscles of the Leg. 

3. The Patella. 

4. Ligament of the Patella. 

5. The Cancellated Structure of the Head of the Tibia. 

6. A Bursa situated between the Ligament of the Patella and the Head 

of the Tibia. 

7. The Mass of Fat projecting into the Cavity of the Joint below the 
Patella. ** The Synovial Membrane. 

The Pouch of the Synovial Membrane, which ascends between the 
Tendon of the Extensor Muscles of the Leg and the Front of the 
Lower Extremity of the Femur. 

One of the Alar Ligaments. The other has been removed with the 
opposite section. 

10. The Ligamentum Mucosum left entire — the Section being made to 

its inner side. 

11. The Anterior or External Crucial Ligament. 

12. The Posterior Ligament. The scheme of the Synovial Membrane, 

which is here presented to the student, is divested of all unneces- 
sary complications. It may be traced from the Sacculus (at 8) 
along the inner surface of the patella; then over the adipose 
mass (7), from which it throws off the Mucous Ligament (10) ; 
then over the head of the Tibia, forming a sheath to the Crucial 
Ligaments ; then upwards along the Posterior Ligament and 
Condyles of the Femur to the Sacculus, where its examination 
commenced. 



8. 



9. 



296 PEACTICAL ANATOMY. 

dyle of the femur, some distance along the head and 
upper part of the shaft of the tibia. 

In front of the articulation is placed the patella, con- 
nected by the Tendo Patella to the tubercle of the 
tibia. 

Ligament of Winslow — a derivation from the tendon 
of the semi-membranosus muscle, passing to the back part 
of the capsular ligament and giving it increased strength. 
If the patella be turned off the front of the joint, a mass 
of fat is seen filling up the space between the condyles 
of the femur and the head of the tibia. A ridge of sy- 
novial membrane on each side of this forms the Alar 
Ligaments. From their junction above starts another 
duplicature of synovial membrane back to the crucial 
ligaments. This is the Ligamentum Mucosum. 

Crucial Ligaments, Anterior and Posterior — the 
first from the inner face of the external condyle, and 
inserted in front of the spinous process of the tibia ; the 
last from the inner face of the internal condyle of the 
femur, and inserted behind the same process of the tibia. 

Semilunar Cartilages — two in number, between 
the femur and tibia. Their posterior and anterior ends 
are fixed behind and in front of the spinous process of 
the tibia. Notice the extent of the synovial membrane 
above the patella. 

Peroneo-tibia I Articu lations. 

The upper end of the fibula is connected to the tibia 
by a capsular ligament, thick in front, and behind form- 
ing the Anterior and Posterior Peroneo -tibial 
Ligaments. At the lower end in the same manner, but 
called there the Anterior and Posterior Inferior Pe- 
roneotibial Ligaments. 

Transverse Ligament — extends between the two 
malleoli on the posterior aspect of the joint. 

Interosseous Ligament — fills up the space between 
the shafts of the two bones. 

The Ankle-Joint. 
Constituted by the tibia, fibula, and astragalus. On 



LATERAL LIGAMENTS. 



297 



the front and behind the joint there exists only the ap- 
pearance of a capsular ligament, but on the sides we 
have the Lateral Ligaments. 

The External Lateral Ligament consists of three 
fasciculi, arising from the external malleolus, and is in- 
serted into the astragalus and the os calcis. 

Internal Lateral Ligament — Arises from the in- 
ternal malleolus, and is inserted into the lesser apophysis 

Fig. 113. 




Internal Ligaments of the Ankle and Foot. 



1. Anterior Fasciculus of the Deltoid Ligament. 

2. Middle Fasciculus. 

3. Posterior Fasciculus. 

4. Groove for the Flexor Digitorum Communis. 

5. Internal Calcaneo-scaphoid Ligament. 

6. Tendon of the Tibialis Posticus. 

7. Tendon of the Tibialis Anticus. 

8. Ligament connecting the Os Scaphoides with the first Cuneiform 

Bone. 

9. Ligament connecting the Scaphoides with the Cuneiform Medium. 
10. Ligaments connecting the first Metatarsal with the first Cuneiform 

Bone. 



298 



PRACTICAL ANATOMY. 



of the os calcis. It spreads out towards its insertion, 
hence sometimes called the Deltoid Ligament. 

Articulations of the Os Calcis and Astragalus. 

^ A very powerful interosseous ligament forms the prin- 
cipal one. 

Fig. 114. 




7 a 

The External Lateral Ligaments op the Ankle and Foot. 

1. Anterior Ligament of the Lower Tibio-fibular Articulation. 

2. External Lateral Ligament, sometimes called Peroneo-calcaneum. 

3. Anterior Fasciculus of the same, or Peroneo-astragalian Ligament. 

4. External Calcaneo-astragalian Ligament. 

5. Interosseous Ligament. 

6. Lower Calcaneo-cuboid Ligament. 

7. Ligament (Ligamentum Dorsale Obliquum), uniting the Fifth Me- 

tatarsal Bone with the Os Cuboides. 

8. Dorsal Ligament of the Fourth Metatarsal Bone. The dorsal sur- 

face of the foot is covered by smaller ligaments that connect the 
tarsal and metatarsal bones, and these again with each other. 



Scaphoid and Astragalus — united by a capsular 
ligament. 



OS CALCIS AND SCAPHOID. 299 

Os Calcis and Cuboides — united by the superior and 
inferior calcaneo-cuboid ligaments passing between the 
two bones. 

The Os Calcis and Scaphoid are very firmly united 
by the internal and external Calcaneo -Scaphoid Liga- 
ments — the former from the lesser apophysis of the os 
calcis to the inner surface of the scaphoid; the latter 
from the greater apophysis of the os calcis to the outer 
end of the scaphoid. Other ligaments, both on the upper 
and lower surface of the foot, connect the different pieces 
together. 



INDEX 



Abdomen, 141 

superficial fascia of, 144 

arteries of, 144 
Abdominal regions, 144 

ring, -external, 145 
internal, 151 
Acervulus, 46 
Air-cells, 254 
Alimentary canaJ, 154 
Amygdalae, 82 
Antihelix, 17 
Antitragus, 17 
Anus, 162 

Antrum m axil 1 are, 94 
Aortic sinuses, 264 
Appendix vermiforniis, 162 
Appendices epiploicae, 58 
Aqueous humor, 283 
Aqueduct of Sylvius, 46 
Arachnoid membrane, 40 
Arbor vita?, 50 
Arch, palmar, 129 
Arytenoid cartilages, 62, 87 
Auricles of heart, 250, 261-263 
Axilla, 97-100 
Axis, coeliac, 170 
Arteries. 

ad cutem abdominis, 144 

alveolar, 28 

anastomotica brachialis, 136 
femoralis, 185 

angular, 23 

aorta, 170—250, 252, 25S 

arcus sublimis, 129 

profundus, 133, 138, 139 

articular, 208 

auricular, 15, 70 

axillary, 76, 101. Ill 

basilar, 51 

brachial, 101, 118, 134 

bronchial, 259 

bulbosi, 228, 234 

2B 



Arteries — com t a aid 
buccal, 28 
carotid, commoN 

external, 27, 08 

internal, 53, 50 
carpal, radial, 118. 138 

ulnar, 139 
cavernosi, 228, 234 
centralis retinae, 9i 
cerebellar, 56 

superior, 56 

inferior, 56 

posterior, 56 
cerebral anterior, 56 

media, 56 
cervicis superficialis, !<■ 

bronceps, 76 

profunda, 76 
circumflex femoral, 181! 

humeral, 102 

ilii, 150, 153, 181 
coeliac axis, 170 
colica dextra, 172 

media, 172 

sinistra, 174 
communicans cerebri. 56 
coronaria cordis, 250, 264 

ventriculi, 170 

labial, 23 
dental, 28 
digitalis manus. 119, 139 

pedis, 216 ' 
dorsalis pollicis, 138 

hallucis, 197 

penis, 228, 230, 234 

scapulae, 102 
einulgesit or renal, 164, 172 
epigastric, deep, 153, 189 

superficial, 144 
facial, 23, 66, 69 

transverse, 24. 7 1 
femoral. 187 



302 



INDEX. 



Arteries — ■continual. 
frontal, 15, 95 
gastric, 170 
gastro-epiploica sinistra, 172 

dextra, 172 
gluteal, 204, 233 
hemorrhoidal, superior, 174 
hepatic, 157, 172 
hypogastric, 230 
ileo-colic, 172 
iliac, common, 174 

external, 174 

internal, 174, 233 
ileo-Iumbar, 233 
infra-orbital, 28, 95 
innominata, 76, 252 
intercostal, 258 

superior, 78, 258 
interosseous, leg, 216 

arm, 118, 128. 139. 140 

pedis, 197, 216 
sschiatic, 205, 233 
labial, 23 
lachrymal, 31 
. laryngeal, 69 
lateralis nasi, 23 
lingual, 68, 69 
lumbar, 174 
magna pollicis, 138 
malleolar, 196 
mammary, internal, 78 

external, 101 
masseteric, 23 
maxillary, internal, 27, 70 

superior, 28 

inferior, 28 
meningea magna, 28 

parva, 28 

media, 37 

anterior, 38 

posterior, 38 
mesenteric, superior,, 172 

inferior, 174 
metatarsal, 196 
obturator, 189 
occipital, 15, 70 
oesophageal ,259 
ophthalmic, 95 
pancreaticse, 172 
parotidean, 24 
perforantes, 188 
perineal, superficial, 234 

transverse, 227 
peroneal, 216 
pharyngeal, 28, 70 
phrenic, 78, 170 
plantar, 214 



Arteries — continued. 
popliteal, 208 
princeps cervicis, 76 
palato-maxillary, 28 
profunda cervicis, 76 

femoris, 188 

humeri, superior, 113, 136 
inferior, 113, 136 
pterygoid, 28 
pudic external, 189 

internal, 205, 223, 224 
pulmonary, 250 
pyloric, 172 
radial, 118, 136 

indicis, 138 

recurrent, 118, 137 
renal, 164, 172 
sacral lateral, 

media, 174 
scapular, supra, 76, 108 

posterior, 76 
spheno -palatine, 28 
spleuic, 172 
subclavian, 76, 253 
subscapular, 101 
submental, 66, 69 
superficialis voke, 118, 137 
superficial circumflex ilii, 189 
supra-orbital, 15 
sural, 208 
spermatic, 174, 236 
tarsal, 196 
temporal, 15, 70 • 

deep, 28 
tibial, anterior reeurrens, 195 

posterior, 214, 216 
transverse facial, 70 
thoracie acromial, 101 
thoracic, 101 

longa, 101 

axillary, 101 

humeral, 98 
tympanic, 28 
ulnar, 118, 138 

reeurrens, 118, 13S 

pollicis, 139 
umbilical, 153 
vasa brevia, 172 
vertebral, 54, 56, 76 
thyroid, superior, 69 

inferior, 76 

axis, 76 

Brain, 40 

cortical part of, 40 
hemispheres of, 40 
lobes of, 40 



INDEX. 



303 



Brain — continued. 

medullary part of, 40 
Bladder, 228 
Bronehise, 254 
Brunner's glands, 164 
Bulb of urethra, 239 

Caecum, 162 
Calamus scriptorius, 49 
Capsule of Glisson, 158 
Capsules, supra-renal, 165 
Caput gallinaginis, 238 
Cardiac orifice, 158 
Cartilage, interarticular clavicle, 288 
of jaw, 284 
of wrist, 292 

semilunar, 296 
Caruncula laehrymalis, 94 

myrtiformes, 241 
Cauda equina, 56 
Ceruminous glands, 17 
Centrum ovale majus, 42 

minus, 42 
Cerebellum, 49 
Cerebrum, 40 
Chambers of the eye, 280 
Chordae tendineae, 202 

vocales, 90 

Willisii, 37 
Choroid plexus, 44 
Ciliary ligament, 280 
Circle of Willis, 53 
Clitoris, 240, 241 
Colon, 154, 162 
Columna nasi, 35 
Columnar carneae, 262 
Columns of spinal cord, 58 
Concha, 16, 17 

Columns of abdominal ring, 145 
Commissures of brain, 46 
Conjoined tendon, 151 
Conjunctiva, 91, 208 
Cornea, 280 
Cornua of the ventricles of brain, 42 

amnion is, 48 
Corpora albicantia, 48 

arantii, 263 

cavernosa, 230 
Corpus spongiosum, 229 
Corpora pyramidalia, 50 

geniculata, 45 

olivaria, 51 

restiformia, 51 

quadrigemina, 46 

striata, 45 
Corpus callosum, 41 

fimbriatum, 48 



Corpus — continued. 

dentatum, 48 

psalloides, 44 
Cowpers glands, 228, 229, 239 
Cranial nerves, 53 
Cricoid cartilage, 62, 87 
Crura cerebelli, 51, 56 

cerebri, 51 

penis, 228 
Crural arch, 147 

canal or ring, 169 
Crystalline lens, 282 

Dartos, 236 

Ductus ad nasum, 94 

arteriosus, 253 

communis choledochus, 158 

cysticus, 158 

ejaeulatorius, 230, 238 

hepaticus, 158 

pancreaticus, 164 

prostatic, 238 

thoracic, 166, 176, 252, 259 

venosus, 158 

parotid, 24 

lachrymalis, 94 
Duodenum, 160 
Dura mater, 36 

Ear, 16 

Endocardium, 261 
Exocardium, 260 
Epididymis, 236 
Epiglottis cartilage, 62, 85, 87 
Eustachian tube, 82 

valve, 261 
Eye, 280 
Eyebrows, 15 
Eyelids, 94 

Falciform process, 1 74 

or semilunar edge, 174, 179 
Fallopian tubes. 243, 244 
Falx cerebelli, 38, 48 

cerebri, 38 
Fascia — 

cervical, 59 

crural, 169 

cribriform, 177 

iliac, 169 

infundibular, 151 

intercolumnar, 147 

intermuscular, 211 

lata femoris. 177 

lumbar, 270 

palmar, 128 

pelvic, 231 



304 



INDEX. 



Fascia — continued, 

pectineal, 179 

perineal, 224 

plantar, 217 

propria, 179 

sartorial, 179 

spermatic, 147 

subaponeurotic, 15 

temporal, 25 
Fauces, 82 
Fissure cerebri, 41 

Sylvii, 41, 50 

of the liver, 157 

of spinal cord, 57 
Flocculus, 50 
Foramen caecum, 85 

commune anterius, 45 

of Monroe, 43 

of Winslow, 156 

Thebesii, 261 
Fornix, 43 
Fossa, ischio-rectal, 224 

oralis, 261 
Fourchette, 239 
Fraena epiglottidis, 85 
Frsenum linguae, 68 

Gall-bladder, 154 
Ganglia, cervical, 72 

Casserian, 54 v 

impar, 176, 256 

lenticular, 96 

semilunar, 256 

lumbar, 256 

sacral, 256 
Glands of Brunner, 164 

ceruminous, 17 

Cowper, 228, 229, 239 

inguinal, 177 

lachrymal, 31, 94 

lymphatic, 101 

mammary, 97 

mesenteric, 156 

Pacchionian, 37 

parotid, 61 

Peyer, 164 

pineal, 46 

pituitary, 53 

sublingual, 66 

submaxillary, 61, 65 

thymus, 253 
Glans clitoridis, 240 

penis, 229 
Globus major, 236 

minor, 236 
Glottis, 87 
Guthrie's muscle, 228 



Heart, 260 
Helix, 16 
Hernia, 151 

femoral, 178 

inguinal, 151 

ventro-inguinal, 151 
Hey's ligament, 178 
Hippocampus major, 47 

minor, 48 
Horner's muscle, 94 
Humors of eye, 282 
Hyaloid membrane, 282 
Hymen, 240 

Ileo-coecal valve, 162, 164 
Infundibulum, 51, 53 
Intercolumnar fascia, 147 
Intervertebral substance, 285 
Intestinal canal, 154 
Iris, 280 

Ischio-rectal fossa, 224 
Isthmus of the fauces, 82 
Iter ad infundibulum, 46 

quartum ventriculum, 46, 50 

Jejunum, 160 
Joint, ankle, 296 

elbow, 290 

hip, 293 

lower jaw, 284 

knee, 294 

shoulder, 289 

wrist, 291 

Kidneys, 164 

Labia majora, 239 

minora, 240 
Lachrymal canals, 94 

gland, 31, 94 

puncta, 94 

caruncle, 94 

sac, 94 
Larynx, 61 
Lateral ventricles, 42 
Lenticular ganglion, 96 
Locus perforatus, 51 
Ligaments, 283 

acromio-clavicular, 288 

alar, 296 

annular of ankle, 29P> 
wrist, 115 

arcuatum, 166 

of bladder, 230 

calcaneo-cuboid superior, 299 
inferior, 299 

calcaneo-scaphoid, internal, 299 



INDEX. 



305 



Ligaments — continued. 

calcaneo-seaphoid, external, 

capsular of hip, 293 
of jaw, 284 
of shoulder, 289 
of elbow, 290 

cotyloid, 294 

conoid, 288 

coracoid, 289 

coraco-acromial, 289 
clavicular, 288 

coraco-humerales, 289 
accessory, 289 

coronary, 290 

costo-clavicular, 288 
transverse, 288 

coccigeal, 286 

crucial, 296 

deltoid, 298 

of elbow-joint, 290 

ileo-lumbar, 286 

interosseous, 290, 296 

of the ankle-joint, 296, 298 

of the knee-joint, 294, 296 

of the hip-joint, 293, 294 

of the wrist-joint, 291, 292 

of the phalanges, 293 

of the pelvis, 286 

of shoulder-joint, 289 

occipito axoid, 286 
atloid, 285 

radio-ulnar, 290, 292 

radio-carpal, 292 

sacro-ischiatic, 287, 288 

sacro-vertebral, 286 

tibio-fibular, 296 

tarsal, 292 

temporo-maxillary, 284 

phalangeal, 293 

patella, 296 

palpebrae, 94 
Ligamentuni nuchas, 265 
Linea alba, 145 

semilunaris, 145 

transversa, 145, 152 
Liver. 157 
Lobus caudatus, 157 

Spigelii, 157 

quadratus, 157 
Lungs, 247, 248 
Lymphatic glands, 101 

Mammae, 97 
Mediastinum, 247 
Medulla oblongata, 51 
Membranous urethra, 238 
Mesentery, 156 



Mesocolon, 157 
299 Mitral valve, 264 
Mons veneris, 239 
Monticulus, 49 
Morsus diaboli, 244 
Muscles — 

abductor indicis, 132 

brevis, 184 

longus, 185 

magnus, 186 

minimi digiti pedis, 218 

minimi digiti, 132 

oculi, 92 

pollicis manus, 129 
pedis, 218 
anconeus, 125 
acceleratores uringe, 225 
accessorius, 219 
anterior auris, 16 
anti-tragic us, 17 
arytenoideus, 89 
aryteno-epiglottideus, 90 
attollens aurem, 16 
auricularis, 124 
azygos uvula?, 84 
biceps flexor cruris, 202 
biceps flexor cubiti, 110 
brachialis anticus, 112 
buccinator, 21 
cervicales ascendens, 273 
circumflexus palati, 84 
coccygeus, 228 
complexus, 274 
compressor-naris, 19 
constrictor isthmi faueium, 82 

pharyngis, 85, 86 
coraco-brachialis, 111 
corrugator supercilii, 19 
cremaster, 150, 236 
crico-arytenoid lateralis, 8S 

posticus, 87 
crico-thyroideus, 63 
crurams, 183 
deltoid, 106 

depressor labii superioris alaeque 
nasi, 23 

anguli oris, 21 

labii inferioris, 21 

oculi, 92 
diaphragm, 165 
digastricus, 63 
erector clitoridis, 244 

penis, 224 

spina, 271, 272 
extensor carpi radialisbrevior, 123 
longior, 122 

brevis digitorum pedis, 194 

26* 



306 



INDEX. 



Muscles — continued. 

extensor digitorum communis, 
123 
longus digitorum pedis, 191 

indicis, 127 
minimi digiti, 124 
ossis metacarpi pollicis, 126 
primi internodii, 126 
proprius pollicis pedis, 191 
secundi internodii, 127 
ulnaris, 125 
flexor brevis pollicis manus, 131 
minimi digiti pedis, 220 
pedis, 220 
carpi radialis, 115 

ulnaris, 117 
digitorum brevis pedis, 219 

longus pedis, 212 
longus pollicis manus, 120 
ossis metacarpi pollicis, 130 
parvus minimi digiti, 132 
pollicis longus manus, 120 
profundus digitorum, 119 
sublimis digitorum, 117 
gastrocnemius, 208 
gemellus, 200 
genio-hyoglossus, 67 

hyoideus, 67 

gluteus maximus, 198 

medius, 198 

minimus, 199 

gracilis, 184 

helicis major, 17 

minor, 17 
hyo-glossus, 68 
iliacus, 169 
indicator, 127 
infra-spinatus, 107 
intercostales, 278, 279 
interossei manus, 133 

pedis, 220, 223 
inter-spinales, 277 
inter-transversales, 278 
latissimus dorsi, 265 
levator anguli oris, 21 
ani, 227. 243 
costarum, 278 
labii superius, 19 
inferius, 24 



palpebral, 91 

scapula;, 267 
lingualis, 85 
lingua? superficialis, 85 

transversalis, 85 

verticals, 85 
long-issimus dorsi, 271 



Muscles — continued. 
longus colli, 81 
lumbricales, 129, 220 
masseter, 24 
multifidus spinae, 277 
mylo-hyoideus, 66 
obliquus externus abdominis, 144 
internus abdominis, 147 
capitus superior, 276 

inferior, 276 
oculi, 92, 93 
obturator externus, 202 

internus, 200 
occipito frontalis, 15 
omo-hyoideus, 62 
opponens, 131 
orbicularis oris, 23 

palpebrarum, 18 
palato-glossus, 82 

pharyngeus, 83 
palmaris brevis, 128 

longus, 116 
pectinalis, 184 
pectoralis major, 98 

minor, 98 
peroneus brevis, 194 
longus, 192 
tertius, 194 
plantaris, 210 
platysma myoides, 59 
popliteus, 211 
pronator quadratus, 121 

radii teres, 115 
psoas magnus, 168 

parvus, 168 
pterygoideus externus, 26 

internus, 27 
pyramidalis, 153 
pyriformis, 199 
quadratus femoris, 201 
rectus abdominis, 152 

capitis anticus major, 81 
minor, 81 
lateralis, 81 
posticus minor, 275 
major, 275 
femoris, 181 
oculi externus, 92 
inferior, 92 
internus, 92 
superior, 92 
retrahens aurem, 16 
rhomboideus major, 266 

minor, 277 
sacro-lumbalis, 271 
sartor i us, 181 
scalenus anticus, 79 



INDEX. 



307 



Muscles — continued. 

scalenus medius, 79 

posticus, 79 
semi-membranosus, 204 
semi-spinalis, 275 
semi-tendinosus, 203 
serratus niagnus, 268 

posticus inferior, 269 
superior, 268 
soleus, 209 

sphincter ani internus, 227 
externus, 227, 243 

vaginae, 241 
spinalis dorsi, 272 
splenitis, 269 
sterno-hyoideus, 62 

cleido mastoideus, 61 

thyroideus, 62 
stylo -glossus, 65 

hyoideus, 65 

pharyngeus, 65 
subclavius, 99 
subscapularis, 109 
supinator brevis, 126 

longus, 122 
supra-spinatus, 107 
temporal, 25 
tensor-palati, 84 

tarsi of Horner, 94 

vaginas femoris, 180 
teres major, 109 

minor, 109 
thyro-arytenoideus, 88 

epiglottideus, 90 

hyoideus, 63 
tibialis anticus, 191 

posticus, 213 
trachelo-mastoideus, 273 
tragic us, 17 
transversalis colli, 273 

abdominis, 150 
transversus auris, 17 

perinei, 226 
alter, 227 
transversalis pedis, 220 
trapezius, 264 
triangularis sterni, 279 
triceps adductor femoris, 184 

extensor cubiti, 112 
vastus externus, 183 

internus, 183 
zygomaticus major, 20 

minor, 20 
musculi pectinati, 261 
nares, 35 
nasal duct, 34 
nates cerebri, 46 



Nerves, abducentes, 54, 96 

accessories, spinal, 51, 61, 75 
auricularis magnus, 59 
cardiac, 254 
cervical, 29, 32 
cervico-spinal, 75 
chorda tympani, 32 
ciliary, 31 
circumflex, 102 
communicans noni, 73 
cranial, 53 
crural, 33, 189, 235 
cutaneous externus of arm, 103, 
140 

internus, 103, 105, 111, 114, 
142 

of the thigh, 177 
dental anterior, 23 

inferior, 32 

posterior, 31 
descendens noni, 73 
digital, 129, 141, 142 
dorsal, 33 
eighth pair, 34 
facial, 34 
fifth pair, 31, 54 
first pair, 53 
fourth pair, 54, 96 
frontal, 15, 31, 96 
glosso-pharyngeal, 55, 71 
gluteal, 205 
gustatory, 27, 32 
hypoglossal, 55, 68, 73 
inferior maxillary, 23 
infra-trochlear, 3] 

orbital, 20, 31, 96 
intercosto-humeral, 103 
ischiaticus major, 33, 205, 235 

minor, 205 
lachrymal, 31 
laryngeal inferior, 34, 76, 260 

recurrent, 34, 76, 260 

superior, 71 
lingual, 55, 6S, 73 
lumbar, 33 
maxillary inferior, 23 

superior, 31, 96 
median, 103, 118, 140 
motor oculi, 53, 95 
musculo-spiral, 103, 113, 118, 142 
nasal, 31, 96 
ninth pair, 55, 68, 73 
obturator, 33, 185, 190, 235 
occipitalis major, 16 

minor, 59 
oesophageal, 71 
olfactory. 53 



308 



INDEX. 



Nerves — continued. 
optic, 53, 95 

tracts, 53 
pathetici, 54, 96 
par vagum, 55, 71, 176, 260 
perforans Casserii, 103, 140 
peroneal, 190, 206 

cutaneous, 208 
phrenic, 32, 75, 253 
plantar, 217 

pneumogastric, 55, 71, 176, 260 
popliteal, 205, 206 
portio dura, 16, 23, 29, 55 

mollis, 55 
pudic internal, 205 
pulmonary, 103 
radical, 103, 113, 118, 142 
recurrent laryngeal, 34, 76, 260 
respiratory external of Bell, 103 
sacral, 33 
saphenous, long, 187, 189 

short, 187, 189 
sciatic, 33, 205, 235 
second pair, 53, 95 
seventh pair, 16, 23, 29, 55 
sixth pair, 54, 96 
spinal nerves, 58 

accessory, 51, 61, 75 
splanchnic, great, 34, 67, 176, 256 

less, 167, 256 
supra-scapular, 102, 108 
superficial is colli, 59 
superior maxillary, 31, 96 
supra-orbital, 96 
sympathetic, great, 34, 72, 254 
thoracic humeral, 103 
tibial anterior, 197, 206, 208 

post. 208 
trifacial, 31, 54 
trigeminus, 31, 54 
ulnar, 103, 113, 141 
Nipple, 97 
Nose, 35 

cartilages of, 35 
lobulus of, 35 
alae, 35 
Nymphae, 240 

(Esophagus, 62, 166, 259 
Omenta, 154, 156 
Os tincse, 241 
Ovaries, 245 

Pancreas, 163 
Papillae of tongue, 85 

maxima?, 85 

media?, 85 



Papillae — continued. 

minima?, 85 

filiformes, 85 
Parotid gland, 61 
Peduncles of pineal gland, 46 
Penis, 229 

Pericardium, 247, 248 
Perineum, 223 
Peritoneum, 153, 154 
Pes anserinus, 29 

hippocampi, 48 
Peyer's glands, 164 
Pharynx, 62, 82 
Pia mater, 40 
Pineal gland, 46 
Pituitary, 53 
Pleura, 247 
Plexus, axillary, 33 

brachial, 76, 79, 112 

cardiac, 254, 260 

choroid, 44 

gastric, 176 

hepatic, 176 

hypogastric, 256 

lumbar, 277 

mesenteric, 176 

oesophageal, 260 

phrenic, 256 

pulmonary, 260 

renal, 176 

rectiformis, 243 

solar, 176, 256 

sacral, 264 

spermatic, 176 
Prepuce, 232 
Processus vermiformis superior, 49 

inferior, 49, 50 
Pons Varolii, 51 
Processus cerebello ad testes, 46 
Prostate gland, 228 
Prostatic sinus, 238 
Puncta lachrymalia, 94 
Pupil, 280 

Pyloric valve, 158, 164 
Pylorus, 158 

Raphe of perineum, 223 
Rectum, 162, 228, 246 
Retina, 281 
Rima glottidis, 87, 90 
Ring, abdominal, exterior, 145 
interior, 151 
crural, 169 

Sacculus larynges, 90 
Saphenous opening, 177 
Sclerotic coat, 280 



INDEX. 



309 



Scrotum, 236 

Semilunar, 296 

Septum auricularum, 261 

cordis, 248 

crurale, 169 

lucidum, 43 

pectiniforme, 230, 241 
Sigmoid flexure, 162 

valves, 203 
Sinus, aortic, 263 

cavernous, 53 

lateral, 36, 55 

longitudinal, superior, 36 
inferior, 39 

of Valsalva, 263 

rectus, 40, 45 

pocularis, 471 

prostatic, 238 
Small intestines, 154, 158, 160 
Spinal cord, 56 
Spermatic cord, 236 
Spleen, 163 
Sphenoidal folds, 38 
Substantia perforata, 51 
Supra-renal capsules, 165 
Suspensory ligament of liver, 157 
Synovia, 283 
Synovial membrane, 283 
Stylo -maxillary ligament, 61, 65 

Taenia semicircularis, 45 

Tendinous centre of diaphragm, 166 

Tendo-Achillis, 209 

Tentorium cerebelli, 38, 48 

Testes cerebri, 46 

Testicles, 236 

Thalami optici, 45 

Thoracic duct, 166, 176, 252, 259 

Thorax, 247 

Thymus gland, 253 

Tongue, 82, 85 

Tonsils, 82 

cerebelli, 50 
Torcular Herophili, 45, 48 
Trachea, 62, 253 
Tragus, 17 

Triangular ligament, 224, 228 
Tricuspid valves, 261 
Trigonum vesicle, 237 
Tuber cinereum, 51 
Tubercula quadrigemina, 46 
Tuberculum Lowerii, 261 
Tunica albuginea of testicle, 236 

vaginalis, 236 

Urachus, 230 
Ureter, 164, 246 



Urethra, 229, 238, 240, 246 

Uterus, 243 

Uvula, 82 

Urinary bladder, 230 

Vagina, 241 
Vallecula, 50 
Valsalva sinuses, 263 
Valves, Eustachian, 261 

ileo-csecal, 162, 164 

mitral, 264 

pyloric, 158, 164 

tricuspid, 261 

semilunar, 263 

Vieussens, 47, 50 
Valvule conniventes, 160, 164 
Vas deferens, 229 
Veins, abdominal, 175 

axillary, 79, 101 

azygos major, 167, 258 
minor, 167, 258 

basilic, 105 

cava superior, 157, 167, 173, 249, 
250 

cava inferior, 249, 252 

cephalic, 98, 105 
pollicis, 105 

coronary, 261, 248 

comites, 140 

emulgent, 164, 175 

femoral, 189 

Galeni, 45 

gastric, 175 

hepatic, 175 

iliac, 175 

innominata, 252 

intercostal, superior, 257 

jugular, exterior, 59 
interior, 68, 70 

lumbar, 175, 258 

median, 105 

basilic, 105 
cephalic, 105 

mesenteric, 175 

orbital, 95 

popliteal, 208 

pia mater, 40 

portal, 157, 175 

pulmonary, 250 

salvatella, 104 

interna or saphenous major, 177, 
189, 190 
externa, 190, 208 

spermatic, 236 

splenic, 175 

subclavian, 78 

tibial, 197 



310 



INDEX. 



Veins — contimled. 

transversa, 252 
Velum interpositum, 44 

pendulum palati, 82 
Ventricles of the brain, 42 

third, 46 

fourth, 49 

fifth, 42 

lateral, 42 
Ventricles of the heart, 250, 261 

larynx, 90 
Vermiform process, 162 
Valvula conniventes, 160, 164 



Vesiculse seminales, 228, 229 

Vestibule, 240 

Vibrissas, 35 

Villi, 164 

Vitreous humor, 282 

Vulva, 45, 239 

Wharton duct. 61, 65, 66 
Willis circle, 53 
Wilson muscles, 228 
Wrisberg nerve, 103 

Zonula ciliaris, 281 



THE END. 



LRaa^ 



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LIBRARY OF CONGRESS 




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